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'Back-in-the-day' sun worshipers now paying the price?
'Back-in-the-day' sun worshipers now paying the price? While education around skin cancer has increased dramatically, it doesn't help the generations of sun-worshippers for whom the damage has already been done.

We all know someone who fits the bill: fair-skinned, covered in "sun spots" after having spent their younger days soaking up the sun, getting a nice bronze tan (or sunburn) while unwittingly bathing themselves in the sun's harmful UV rays. While education around skin cancer has increased dramatically, it doesn't help the generations of sun-worshippers for whom the damage has already been done. I know, because I am an ex sun worshipper who has survived skin cancer. For these people, proactive skin care and screening is essential.

One of the most common, but also most unknown pre-cancers of the skin is actinic keratosis (AK). When I ask people if they know what actinic keratosis is, I often get the same exact answer, "I've never heard of it." This is somewhat alarming given the fact that these precancerous spots are the third most frequently diagnosed skin problem - affecting upwards of 58 million Americans.

Because there is no way to know ahead of time which AKs will become cancerous, it is very important to seek a dermatologist's care
As a dermatologist, I am proud of and happy about all of the education we have seen around melanoma and skin cancer protection. However, one area where we have not seen enough education is the treatment of pre-cancers such as AK. It is important because, despite the fact that most AKs remain benign, approximately 5-10 percent develop into squamous cell carcinoma within an average of two years. So what are AKs? Actinic keratosis is a precancerous skin condition that is often mistaken for sun spots and is typically diagnosed in older adults. AKs are the result of years of cumulative sun damage and are most prevalent in older adults who have spent a lot of time in the sun over the course of their lives.

AKs most often appear on parts of the body that are regularly exposed to sunlight such as the face, scalp, ears, neck, hands and arms. They are also more common in people with fair skin, so if you're one of those people you should be on particularly high alert.

AKs are rough-textured, dry, scaly patches on the skin that can range in color and vary in size. It is not typical for the sun to affect only small patches of the skin – therefore, people who are diagnosed with an AK will typically develop more AKs. So while there may be one AK on the surface, there may be more nascent AKs that will present over time.

Because there is no way to know ahead of time which AKs will become cancerous, it is very important to seek a dermatologist's care. Don't ignore your sun spots! Frequent skin examinations are the key to early detection and prevention. If you think you have AKs you should see your dermatologist and talk about the best treatment options. To find a dermatologist in your area or for more information on AK, please visit www.spotsigns.com.

There are many treatment options available, and you should discuss which is best for you with your dermatologist. These treatments include:

Photodynamic Therapy
This treatment involves the application of a photosensitizing agent to the AKs. The treated area is exposed to a light that activates the agent. The period between application and exposure will vary and depend on the photosensitizing agent that is used. This treatment targets just the AKs and causes little damage to the surrounding normal tissue. Some redness, swelling and a burning sensation during therapy often occurs.

Cryotherapy (freezing)
This treatment involves freezing the AKs with an extremely cold substance such as liquid nitrogen. There is no cutting or anesthesia required. This method causes the lesion(s) to shrink or become crusted and then fall off. After treatment there may be temporary redness and swelling. In some patients this treatment can cause permanent white spots on the skin.

Topical Medication
This treatment involves the application of a topical medication to the affected skin. The course of treatment can range from days to weeks, depending on the topical medication that is used. Redness, swelling, and ulceration may occur during treatment.

Curettage (scraping)
This procedure involves the use of a curette to scrape off cells that are damaged. A local anesthetic is required for this procedure. Scarring and skin discoloration may occur at the site of the treatment.

Chemical Peel
Chemicals are applied directly to the AKs. The chemical causes the top layer of skin to slough off. This layer of skin is usually replaced within seven days. Anesthesia is necessary for this procedure and temporary discoloration and irritation can occur.

This procedure involves using a rapidly moving brush to remove the affected skin. Local anesthesia is used. Following the procedure, the skin appears red and raw-looking. It can take as long as several months for the treated area to heal.

Surgical Excision
With surgical excision, the entire lesion with some healthy tissue is removed. Scarring is possible with this procedure.

This treatment involves focusing a laser on the lesion. The laser cuts through the skin tissue without causing bleeding. Local anesthesia may be required. This treatment can cause pigment loss in the skin.

As always, it is imperative to talk to your dermatologist if you think you have AKs, but if you'd like to learn more, please visit www.spotsigns.com. This site has a variety of educational tools including a list of signs, prevention advice, and treatment options. It can even help you find a nearby dermatologist.

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