Our Treatment Approach for Precancerous Actinic Keratoses

Hello, my name is Dr. Thomas Knackstedt, and I’m a board-certified dermatologist and board-certified, fellowship-trained Mohs surgeon at Peak Skin Center. In this video, I want to talk about our approach to treating actinic keratoses.

Because precancers are early and superficial, their treatment is usually fairly conservative. There are several different options that most dermatologists use. An individual actinic keratosis is most often—and most easily—treated by freezing it with liquid nitrogen. This is typically done with a small spray device. The treated area usually becomes slightly red and may occasionally blister or form a scab. It then heals, with the actinic keratosis resolved and the skin returning to normal, or sometimes appearing slightly lighter or redder.

This approach works very well for treating a single precancer. However, when patients have multiple lesions, treatment can start to feel like a game of “whack-a-mole,” where one or more spots are constantly being frozen.

In those situations, it can be helpful to treat a broader area of sun-damaged skin using a cream, photodynamic therapy, or a chemical peel. Photodynamic therapy applies a specific topical medication to the target skin in the office. This medication is preferentially taken up by precancerous cells during an incubation period. Thereafter, the medication is activated by shining a specific red or blue wavelength of light on the area. Chemical peels are applied in the office as a one-time treatment and remove the most superficial layer of the skin, helping to treat multiple precancerous lesions at once.

Alternatively, patients with larger areas of precancerous skin can often be treated with prescription topical creams. Depending on the specific medication, the extent of sun damage, and the treatment plan, different products and regimens may be used. Most creams are applied once or twice daily for about 10 to 21 days. These treatments typically work by creating redness and inflammation in the treated area.

It’s important to note that these medications make the skin more sensitive to the sun, so it’s best to undergo treatment during a time when you can avoid significant sun exposure for several days.

As with freezing individual lesions, the goal of these broader treatments is to restore healthy, normal skin. After healing, any remaining spots that appear concerning or have progressed beyond an actinic keratosis can be further evaluated or treated as needed.

If you or a loved one has noticed rough, scaly patches on your skin, it may be actinic keratoses, an early form of skin cancer. Schedule a consultation with a board-certified dermatologist at Peak Skin Center, where our specialists offer expert care in diagnosing and treating pre-cancerous skin conditions. Renowned across Cary, Apex, Holly Springs, and Fuquay-Varina, our dermatologists provide comprehensive, personalized treatments to prevent further progression. Visit us at any of our convenient locations to take proactive steps toward healthier skin today.