Actinic keratoses are rough, red, lesions usually found on the light exposed areas of the body particularly the face and upper extremities in fair complexioned people which are precursors of squamous cell carcinoma. They can occur as solitary lesions or can be found in considerable numbers. They are the direct result of excessive sun exposure in the patients’ early childhood and young adult life. Once they start to appear, there is a propensity for them to increase in number even if sun exposure is significantly curtailed. The rough spots can often be felt before actually seen. As the lesions develop, they enlarge, the surface becomes rougher and more elevated.
A cutaneous horn is an old actinic keratosis with a hard horny projection overlying the lesion. The horn can be quite large. As these lesions continue to mature, a nodule not infrequently develops under the horn and pain or tenderness become apparent. These lesions have become squamous cell carcinoma in situ (limited to the epidermis). With more time, invasive squamous carcinoma develops.
Many forms of destructive therapy are available to deal with these lesions and are extremely effective. Maintenance therapy at regular intervals is often recommended since new lesions continue to develop. These same patients are much more likely to develop basal cell carcinomas as well. Detecting these cancers when they are small, and before they exhibit tissue destruction, is certainly in the patient’s best interest. If you think you might have any of these lesions, please see a dermatologist.