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Actinic keratoses are the rough, scaly patches that years of sun leave on the face, scalp, ears and hands. Some of them go on to become squamous cell carcinoma. At Rejuvenation Dermatology Calgary South, Dr. Paul Kuzel, a board-certified dermatologist, diagnoses and treats them in the same visit, so they never get the chance.
An actinic keratosis is a patch of skin where ultraviolet damage has altered the cells of the outer layer but not yet broken through to the layer beneath. It is the most common precancerous skin condition there is, and the direct precursor of squamous cell carcinoma.
Many people find their first actinic keratosis with a fingertip. The texture changes before the colour does.
Any of these suggest a patch may already have progressed and needs a sample rather than a treatment.
Actinic keratosis is a marker of damage across a whole area of skin, not a single spot. Treating it well means seeing the whole field, and knowing which patches to freeze, which to treat as a group, and which to sample.
Actinic keratosis is a total of every hour of sun since childhood. High altitude, thin dry air and long winters on reflective snow mean Calgary skin gets more of that total than most people expect.
Assessment and treatment of actinic keratosis is medical care, and is generally covered by Alberta Health Care with a referral from your family physician. Ask your doctor to refer you to Dr. Paul Kuzel at Rejuvenation Dermatology Calgary South, or have the referral faxed to (403) 225-2914.
If you do not have a family doctor, or you would rather not wait, call (403) 286-6888 and the team will walk you through the fastest way to be seen. Some field treatments, such as laser resurfacing, are cosmetic and are quoted separately.
A few scattered patches are treated one at a time. A whole area of damaged skin is treated as a field. Thick or suspicious patches are sampled first. Most people need one approach, some need two in sequence.
Liquid nitrogen is applied to each patch for a few seconds. The damaged cells freeze and peel away over the following week or two. The standard first treatment for a small number of thin lesions.
A topical medication applied at home for days to weeks treats every patch in an area at once, including those too small to see. The skin reddens and peels while it works, then heals smoother than it started.
A light-sensitising cream is applied to the area, absorbed preferentially by the abnormal cells, then activated with a lamp in the clinic. One session treats the whole field with a shorter recovery than creams.
For skin with extensive damage, a fractional CO₂ laser or a medium-depth peel removes the damaged outer layer across the whole area and stimulates new, healthier skin beneath it.
A thick, horn-like or recurring patch is scraped away under local anaesthetic and the base is treated with heat. Often combined with a sample sent to pathology to rule out progression.
ElectrocauteryA patch that is thick, tender, bleeding or growing quickly may already be a squamous cell carcinoma. It is sampled under local anaesthetic before anything else, and the pathology decides the next step.
Skin cancer careA first visit at Rejuvenation Dermatology Calgary South usually runs twenty to thirty minutes, and for a small number of patches the treatment happens before you leave.
Treating an actinic keratosis clears the patch. It does not undo the decades of sun that produced it, and the same skin will produce more unless the exposure changes. Sun protection after a diagnosis is not general advice. It is the second half of the treatment.
That means a broad spectrum sunscreen of SPF 30 or higher on the face, ears, neck and hands every day, including in winter, and reapplied when you are outside for long. A brimmed hat if your scalp is exposed. Shade in the middle of the day. No tanning beds, ever.
It also means a yearly full body skin check, because once you have had one actinic keratosis you are in the group most likely to develop a squamous cell carcinoma, and the point of the check is to find it while it is still small. Between visits, run a fingertip over the areas you know are at risk once a month. Rough is the first sign.
No. It is a precancer, meaning the cells are abnormal but have not invaded the deeper layer of the skin. A minority of patches go on to become squamous cell carcinoma over years, and because there is no way to predict which, dermatologists treat them rather than watch them.
For any single patch the risk is small, in the range of a few percent over several years. The difficulty is that most people with actinic keratosis have many patches, and the risk adds up across all of them. Around six in ten squamous cell carcinomas arise from an actinic keratosis, which is why treatment is recommended for all of them.
Some thin ones do fade, particularly if sun exposure stops, and then return. A patch that comes and goes is still an actinic keratosis and the underlying damage is still there. Treatment clears them reliably. Waiting for them to leave does not.
A brief sting and burning sensation during the few seconds of freezing, then some tenderness for a day. A blister or crust forms and falls away over one to two weeks. No anaesthetic is needed for the typical small patch.
They cause the abnormal cells to inflame and peel away. Expect redness, crusting and some discomfort over the treated area for two to four weeks, which is the treatment working, then healing to skin that is smoother than it started. The reaction can look dramatic, so many people time it around their calendar. Dr. Kuzel will show you what to expect and how to manage it.
It depends on how many patches there are, how thick they are, where they are and how much recovery you can accommodate. A handful of thin lesions are frozen on the day. A scalp or face with many lesions is usually treated as a field with a cream or photodynamic therapy. Thick ones are scraped and often sampled. The plan is made at the first visit and explained before anything is started.
Assessment, biopsy, cryotherapy and medical field treatments for actinic keratosis are generally covered with a physician referral. Prescription creams are covered by most drug plans. Laser resurfacing and chemical peels are cosmetic procedures and are quoted separately.
Cryotherapy occasionally leaves a pale spot, more noticeable on darker skin, which is why it is used selectively. Creams and photodynamic therapy treat the surface and do not scar. Curettage of a thick lesion leaves a small flat mark that fades. In all cases the result is better than the scar from removing a squamous cell carcinoma later.
The treated patch usually does not. New patches in the same area are common, because the surrounding skin carries the same sun damage. That is the case for field treatment where many are present, for daily sun protection afterwards, and for a yearly skin check so that anything new is found and treated early.
Dr. Paul Kuzel, MD FRCPC, a board-certified dermatologist and the founder and Medical Director of Rejuvenation Dermatology Calgary South. He sees patients in English and Czech.
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Most actinic keratoses are treated in the same visit they are diagnosed. Book an assessment with Dr. Kuzel, or ask your family physician for a referral.
Rejuvenation Dermatology Calgary South
10201 Southport Rd SW #102
Calgary, AB T2W 4X9
Two blocks west of the Delta Hotel
(403) 286-6888
Referrals by fax: (403) 225-2914
Open seven days a week, with early mornings and evenings on weekdays.
Take the first step toward achieving healthy, radiant, and flawless skin. Contact Rejuvenation Medical Aesthetics today to schedule your personalized consultation and explore the advanced treatments tailored to your unique needs.
