Early treatment can eliminate almost all actinic keratoses before they become skin cancers. If an AK is suspected to be an early cancer, the physician may take tissue for biopsy by shaving off a portion of the AK with a scalpel or scraping the lesion with a curette (an instrument with a sharp ring-shaped tip). The curette may also be used to scrape off the base of the lesion. Bleeding is stopped with an electrocautery needle, or by applying trichloroacetic acid (TCA). Local anesthesia is necessary.
Depending on the nature of the growth and the patient’s age and health, various treatment options are available for actinic keratosis, including the following: [For more details on these treatments, see our Treatment Glossary].
These are most widely used for individual AKs.
- Cryosurgery: The physician applies liquid nitrogen to the AK to freeze the tissue. Later, the lesion and surrounding frozen skin may blister or become crusted and fall off.
- Curettage and desiccation: The physician scrapes or shaves off part or all of the lesion, then applies heat or a chemical agent to stop the bleeding and potentially kill any remaining AK cells.
- Laser surgery: The physician uses intense light to vaporize AK tissue.
If you have numerous or widespread actinic keratoses, your doctor may prescribe a topical cream, gel or solution. These can treat visible and invisible lesions with a minimal risk of scarring. Doctors sometimes refer to this type of therapy as “field therapy,” since the topical treatments can cover a wide field of skin as opposed to targeting isolated lesions.
- 5-fluorouracil (Carac®, Efudex®, Fluoroplex®): a form of topical chemotherapy.
- Chemical peel: Best known for reversing the signs of photoaging, this technique is also used to remove some superficial actinic keratoses on the face, especially when other techniques have not succeeded. The physician applies trichloroacetic acid and/or similar chemicals to the face, causing the top skin layers to slough off.
- Diclofenac (Solaraze®) and hyaluronic acid: a combination topical therapy.
- Imiquimod (Aldara®, Zyclara®): A form of topical immunotherapy, it stimulates the immune system to produce interferon, a chemical that attacks cancerous and precancerous cells.
- Ingenol mebutate (Picato®): A rapidly effective topical therapy derived from plants. An immunologic mechanism of action has been proposed
Photodynamic therapy (PDT) is especially useful for widespread lesions on the face and scalp. The physician applies a light-sensitizing topical agent to the lesions, then uses a strong light to activate the topical agent, destroying the AKs while sparing healthy tissue. [In Europe, some physicians follow application of the light-sensitizing agent with exposure to sunlight instead of artificial light; this is known as daylight PDT, and it is considered a gentler treatment than standard PDT.]
Doctors may combine therapies for a period of time to treat AKs. Typically, treatment regimens combine cryosurgery with PDT or a topical agent like imiquimod, diclofenac, ingenol mebutate, or 5-fluorouracil (5-FU). The topical medications and PDT may also be used alternately every three months, six months or year, as determined by the physician at follow-up skin examinations.
Note: Some of these strategies increase sun sensitivity, so check with your doctor, and be especially diligent about using sun protection during the treatment period.
Mark Lebwohl, MD
Deborah S. Sarnoff, MD