As you get older, you may begin to notice rough, scaly spots appearing on your hands, arms, or face. These spots are called actinic keratoses, but they’re commonly known as sunspots or age spots. Actinic keratoses usually develop in areas that have been damaged by years of sun exposure. They form when you have actinic keratosis (AK), which is a very common skin condition.
AK occurs when skin cells called keratinocytes start to grow abnormally, forming scaly, discolored spots. The skin patches can be any of these colors:
They tend to appear on the parts of the body that get the most sun exposure. This includes the:
In most cases, actinic keratoses are not cancerous. They are considered “in situ” stage squamous cell carcinoma (SCC) lesions. “In situ” means the lesions are confined to one location and not invading other tissues. When they’re left untreated, however, up to 10 percent of actinic keratoses can progress into SCC. SCC is the second most common type of skin cancer. Due to this risk, the spots should be regularly monitored by your doctor or dermatologist.
AK is primarily caused by long-term exposure to sunlight. You have a higher risk of developing this condition if you:
- are over age 60
- have light-colored skin and blue eyes
- have a tendency to sunburn easily
- have a history of sunburns earlier in life
- have been frequently exposed to the sun over your lifetime
- have the human papilloma virus (HPV)
Actinic keratoses start out as thick, scaly, crusty skin patches. These patches are usually about the size of a small pencil eraser. There might be itching or burning in the affected area.
Over time, the lesions can disappear, enlarge, remain the same, or develop into SCC. There’s no way of knowing which lesions may become cancerous. However, you should have your spots examined by a doctor promptly if you notice any of the following changes:
- hardening of the lesion
- rapid enlargement
Don’t panic if there are cancerous changes. SCC is relatively easy to diagnose and treat in its early stages.
Your doctor may be able to diagnose AK simply by looking at it. They may want to take a skin biopsy of any lesions that look suspicious. A skin biopsy is the only foolproof way to tell if lesions have changed into SCC.
AK may be treated in the following ways:
Excision involves cutting the lesion from the skin. Your doctor may choose to remove extra tissue around or under the lesion if there are concerns about skin cancer. Depending on the size of the incision, stitches may or may not be needed.
In cauterization, the lesion is burned with an electric current. This kills the affected skin cells.
Cryotherapy is a type of treatment in which the lesion is sprayed with a cryosurgery solution, such as liquid nitrogen. This freezes the cells upon contact and kills them. The lesion will scab over and fall off within a few days after the procedure.
Certain topical treatments called chemical peels, such as 5-fluorouracil, kill the affected skin cells and cause the lesion to scab over and drop off. While this type of treatment can get rid of the lesions, it may be temporarily disfiguring. Make sure to ask your doctor about the possible side effects of chemical peels and what to expect after treatment.
During phototherapy, a solution is applied over the lesion and the affected skin. The area is then exposed to intense laser light that targets and kills the cells. Common solutions used in phototherapy include prescription medications, such as aminolevulinic acid and methyl aminolevulinate cream.
Immunotherapy can involve the use of Imiquimod, which is a topical cream that can be applied to the lesion several times a week. The cream increases the activity of the body’s immune system, but it’s not exactly known why this helps treat AK.
The best way to prevent AK is to reduce your exposure to sunlight. This will also help minimize your risk of skin cancer. Remember to do the following:
- Wear hats and shirts with long sleeves when you’re in bright sunlight.
- Avoid going outside at midday, when the sun is brightest.
- Avoid tanning beds.
- Always use sunscreen when you’re outside. It’s best to use a sunscreen with a sun protection factor (SPF) rating of at least 30. It should block both ultraviolet A (UVA) and ultraviolet B (UVB) light.
It’s also a good idea to examine your skin regularly. Look for the development of new skin growths or any changes in all existing:
Make sure to check for new skin growths or changes in these places:
- the tops and undersides of your arms and hands
Schedule an appointment with your doctor as soon as possible if you have any worrisome spots on your skin.