News & Articles

AKs are Not OK!

"about 1 in 10 of these lesions will evade detection and become a
skin cancer called a Squamous Cell Carcinoma"

Staci Hestdalen, MD
Advanced Dermatology & Skin Surgery
Board Certified Dermatologist, FAAD
Associate Clinical Professor, University of Washington

   Do you remember those glorious childhood days spent frolicking around the neighborhood, playing in the pool, mowing the lawn, hanging at the beach, or working at the farm? Do you remember how you spent those days free of the worry of wearing hats, sunscreen, and were oblivious to the havoc the sun was reeking on your pristine young unprotected skin?

Well....those glory days can come back to haunt us later in life. What nobody was telling us while we were gleefully skipping around the playground is that the radiation in the sun's rays was silently mutating our skin cells (also known as keratinocytes). As early as the 4th and 5th decade of life these previously silent mutations begin to manifest as crusty areas on the skin. These lesions are typically easier to feel than see and most commonly develop in areas where we have had chronic sun exposure such as the face, scalp, backs of hands and forearms. The lesions that develop may sting and tend to regrow even after being "picked off". In Dermatology we refer to these areas of mutated keratinocytes as actinic keratosis (better known as AKs).

Actinic keratosis represent areas of mutated keratinocytes which are multiplying faster than the rate of normal skin and therefore develop localized crusty spots. Fortunately, the body's immune system is capable of finding and destroying most of these mutated keratinocytes before they can become a skin cancer. Unfortunately, about 1 in 10 of these lesions will evade detection and become a skin cancer called a Squamous Cell Carcinoma (SCC). If left untreated a SCC is capable of moving to other parts of the body and in some cases can lead to death.

Our goal in Dermatology is primarily to prevent the radiation exposure that leads to AKs and to treat existing AKs so that they cannot develop into SCC.

Sun protective clothing (including hats) along with sunscreen (Broad Spectrum SPF 30-50) is imperative in helping to prevent the radiation exposure that leads to AKs. It is never too late to start! Regardless of age or previous "sun sins" the body's mechanisms for detecting and destroying these unwanted mutations is always at work and can successfully target these areas if the skin is not constantly being exposed to additional mutagenic radiation. For those lesions that do escape detection there are multiple treatment options. A Dermatologist can access the skin and the extent of involvement. Solitary lesions can be treated successfully with the localized application of liquid nitrogen. Areas of more widespread involvement typically require a "field treatment" which can be accomplished through the application of one of several creams or the use of an in office procedure called Photodynamic Therapy (PDT). A crusty lesion that regrows no matter how many times it is picked off warrants an evaluation and potential treatment.

Dr. Staci Hestdalen