Treatment of Actinic Keratosis A.K.A. Precancers | Anne Marie McNeill M.D., Ph.D

Actinic Keratosis (or keratoses, plural) is a sun-induced thickening of the skin that is precancerous.  If untreated, approximately 10% of actinic keratoses will turn into a skin cancer (basal cell carcinoma or squamous cell carcinoma) over several years.  Most people want to treat their actinic keratoses (AKs) because of both medical and cosmetic reasons.
There are numerous treatment options for AKs.  These include liquid nitrogen, creams, and light-based treatments.
Liquid nitrogen is considered local treatment of AKs.  It is ideal if a patient just has one or a few AKs.  It is done at the office visit and is just a quick “squirt” of cold gas.  The area scabs over and heals usually within 5 – 15 days.  Liquid nitrogen just treats the individual lesions of actinic keratosis that are visible to the naked eye.
Creams or light-based treatments treat a whole field of AKs, as opposed to individual lesions, and will also decrease the chance of more lesions in the future.
The most common cream that I use for AKs is Efudex (or 5-fluorouracil) cream.  Some people will call this “chemo cream,” because intravenous 5-fluorouracil is chemotherapy for certain internal malignancies.  Topically, it treats AKs.  It can only be used over a small body surface area, for concern of systemic absorption of this medication.  It is generally applied to a whole area (for example, a whole forehead or cheek) twice a day for 2 – 4 weeks.  In general the skin will scab and crust during this time.  After stopping the Efudex, the skin will heal, and in general will be much more smooth and fewer or no AKs will be left.
The light-based treatment for AKs is called ALA-Blu Light.  This treatment can transform the texture of the skin from rough/sun-damaged to healthy.  ALA stands for amino-levulanic acid (the brand name is Levulan).  The Blu Light activates the chemical that is produced by the ALA in your skin (protoporphyrin IX) to destroy actinic keratoses.  Patients come into the office and have an incubation with ALA for a certain amount of time (often 3 hours on the face, or 5 hours on the body), then sit under the Blu Light for ~15 minutes.  Although this 15 minutes can be painful, the results are worth it.  Studies show an average of 80-90% reduction in actinic keratoses that lasts for about 5 years after an ALA-Blu light treatment.   This photo shows the change in the skin from a Blu Light (along with some filler and botox).  This treatment is ideal for fair skinned people who want to ward off precancers and skin cancer.