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Ask Dr. K: Treatments for actinic keratosis rarely leave scars

DEAR DOCTOR K: I saw my doctor about a patch of rough, brown skin that I noticed on my upper arm. He said it is actinic keratosis and needs to be removed. Is it cancer? How will it be removed?

DEAR READER: Actinic keratosis (AK) is a precancerous skin condition. That means it is not cancer now, but is likely to become cancerous if left untreated.

AK appears as raised, scaly pink or red-brown rough patches on the skin. The patches are most likely to appear on the face, back of the hands or other areas commonly exposed to the sun. They can cause discomfort and itching.

Doctors have a variety of methods to remove areas of actinic keratosis. Most treatments can remove AK spots without permanent scarring:

— CRYOTHERAPY. “Cryotherapy” means “cold treatment.” The standard treatment for AK is to freeze the area with liquid nitrogen, the temperature of which is well below freezing. Inflammation, swelling and blistering may occur following the treatment. A small scab forms, and then healthy new skin emerges as it heals.

— CREAMS AND GELS. A prescription cream containing a chemotherapy drug can remove a patch of AK. But these creams cause sun sensitivity and, often, considerable discomfort. Another drug applied to the skin stimulates the immune system to release chemicals that fight cancer cells and viruses. This treatment causes AK patches to become inflamed, crust over and heal. Other topical products are also available.

— DEEPER TREATMENTS. If your AK is widespread — if you have multiple AK patches on your face, for example — you may need deeper treatments. These include laser resurfacing or a chemical peel. A chemical peel dissolves the outer layers of the skin with a chemical solution. Laser resurfacing and chemical peels can involve local or general anesthesia. Depending on how deeply the treatments penetrate the skin, they may cause considerable swelling. Another effective treatment involves scraping away damaged tissue and using an electric probe to kill any remaining precancerous cells.

— PHOTODYNAMIC THERAPY uses light to activate a drug that destroys AK cells. The AK patches crust over and heal. This therapy is appropriate when there are many AK spots on the face and scalp.

— SURGERY. While not usually necessary, various types of surgery also may be used. The patch of AK can be cut out. This needs to be done in a surgical suite and usually requires stitches.

Simpler forms of surgery such as curettage and dermabrasion can be done in the doctor’s office. Curettage and dermabrasion involve scraping away the top layer of skin, which contains the AK. It’s not unlike what you do when peeling a carrot.

I spent a lot of time in the sun as a child, and I’ve had more than my share of AKs. They’ve been treated in various different ways, and they’ve all healed nicely.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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