Precancerous Spots (Actinic Keratoses)

Advanced Treatment Options for Actinic Keratoses in the San Diego Area

Dr. Melanie Palm is a nationally recognized dermatologist and cosmetic surgeon specializing in the treatment of precancerous spots called actinic keratoses. Her offices are located in Solana Beach, CA just north of San Diego. Dr. Palm lectures nationally and has written book chapters on the treatment of actinic keratosis. She offers many effective treatment options for precancerous spots.

Precancerous Spot (Actinic Keratosis)

Precancerous spots are referred to in the medical therapy as actinic keratoses. They are related to UV or sun exposure and select chemical exposures such as low-level arsenic in well water. An actinic keratosis (AK) appears as a scaly, rough patch often with underlying erythema in sun-exposed areas such as the face, scalp, hands, and forearms. AK’s are often felt before they are seen.

AKs may occur in upwards of 25% of the U.S. population over a lifetime. In San Diego, CA similar to Australia, sun exposure is frequent and strong, and younger patients often experience these precancerous lesions.   A small percentage of actinic keratoses may progress to form the second most common form of skin cancer, squamous cell carcinoma.   Because of this risk, AKs should be treated and not ignored.

Treatment Options for Precancerous Spots (Actinic Keratoses)

The correct choice or combination of treatment options for precancerous spots depends on the underlying cause of actinic keratoses.

The following treatments are commonly used alone or in combination for AKs:

  • Medical therapy: medications are commonly used to control but not cure facial redness. The correct medication depends on the underlying condition causing facial redness:
    • Cryotherapy or cryosurgery: liquid nitrogen is used to freeze AKs leading to their destruction
    • Topical medications: topical chemotherapy and immunomodulating medications such as 5-fluorouracil (Efudex, Carac), imiquimod (Aldara, Zyclara), ingenol mebutate (Picato), and diclofenac (Solaraze) can be used topically over AK-affected skin to selectively destroy precancerous skin cells.
    • Sunscreen: photoprotection is part of a proactive means to prevent further UV exposure, sun damage, and the development of precancerous spots.
    • Retinoids: prescription-strength vitamin A derivatives such as tretinoin (Retin-A) or tazarotene have been shown to decrease the number and severity of AKs from research dating back to the 1980s.
  • Lasers & Lights:
    • Photodynamic Therapy: PDT is a FDA-approved for the treatment of precancerous lesions called actinic keratoses. This light and chemical-based reaction causes selective destruction of precancerous skin lesions.   Oftentimes, Dr. Palm adds an IPL photofacial treatment in addition to blue light treatment during PDT light activation to improve light-based skin rejuvenation during treatment. She has written a book chapter regarding this specialized form of PDT treatment. This procedure has about 1 week of downtime associated with it.
    • CO2 laser resurfacing: CO2 laser treatment is an ablative treatment meaning it selectively removes and resurfaces a portion of the skin. It requires typically a week of downtime.   A fully ablative treatment (removing 100% of the skin to a certain depth) is the most effective way to use this laser to treat AKs. This cosmetic treatment is not covered by insurance. It is often a treatment of consideration for actinic cheilitis – precancerous skin lesions occurring on the lip.

A combination approach is sometimes ideal to improve the number and severity of precancerous skin lesions. Non-invasive and minimally invasive techniques are often combined with topical skin care regimens at Art of Skin MD to achieve the aesthetic goals of our patients in regards to actinic keratoses.

If you are looking for a dermatologist to treat your precancerous spots or skin cancer in the San Diego area, call Dr. Melanie Palm at 858.792.SKIN (7546) to schedule your appointment.