Solar Keratoses and Skin Cancer
George Woodbury MD 2/7/2023
Let’s take a look at Solar Keratoses (also called Actinic Keratoses) – and Skin Cancer – my perspective being that of a Board-certified Dermatologist in over thirty years of Memphis Dermatology practice at Rheumatology and Dermatology Associates, 8143 Walnut Grove Road, Cordova TN 38018 (www.Rheumderm.com; 1-901-753-0168).
A Solar Keratosis or Actinic Keratosis (plural: Solar Keratoses) is a thickening of the outer layers of the skin caused by exposure to ultraviolet light, often starting in people in their twenties and thirties. Solar keratoses occur in all races, but are more common among Caucasians, particularly among people who work in or play in the sun. They go from flesh-colored to brown, pink, or red, and they often are just dry sometimes cracked areas of the skin, producing no symptoms, but they can also become itchy, or sore.
The main cause of Solar Keratoses is a type of invisible light called Ultraviolet light, or UV light, also the major cause of Skin Cancer, including Melanoma, Basal Cell Skin Cancer, and Squamous Cell Skin Cancer. UV light causing Solar Keratoses comes in two types, called UVB and UVA.
Notably, UVA and UVB are also the major cause of wrinkles, color variability in the skin, a leather-like texture to our skin, a combination of features that dermatologists call photoaging.
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Why are solar keratoses important? Because they’re risk of becoming cancerous. Between 10 and 20% of them later develop into a type of skin cancer called Squamous Cell Carcinoma, or Squamous Cell Skin Cancer, being diagnosed in approximately 400,000 Americans this year, particularly on the hands, arms, trunk, neck, face, and scalp. And that yearly number is increasing. Many Dermatologists believe that over 10,000 Americans die of Squamous Cell Carcinoma yearly in the United States. That’s over three times the number of Americans who lost their lives on September 11th, 2001. It’s also comparable to the number of Americans who love their lives each year to a type of skin cancer called Melanoma, which develops from the pigment-producing cells of the skin.
Dermatologic Surgeons like myself sometimes consider taking a lesion off (excising it), to get it evaluated by the skin laboratory (Dermatopathology Laboratory), to check whether it’s really a Solar Keratosis, or actually a type of Skin Cancer. This type of removal is done after injecting the area with some local anesthetic, and if often requires placement of stitches.
Fortunately, Memphis Dermatologists like myself now have a growing number of treatments and effective prescription medicines for both prevention of and treatment of Solar Keratosis.
First, we have many effective “broad spectrum” sunscreens that protect us against damage from both types of ultraviolet light – both the UVA and the UVB. Examples include Vanicream Sunscreen SPF 50, Shade UVAgarde, and Photoplex.
Secondly, Dermatologists have both therapies in the office and topical medicines to manage prior sun damage and solar keratoses (meaning that these medicines are used “on top of” the skin):
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Many Dermatologists use what’s called cryotherapy to treat solar keratoses. Cryotherapy is defined as the application of extreme cold to remove damaged or diseased tissue, often using application of liquid nitrogen to cause a blister to form below the lesion. The skin then regrows with fresh, new cells from below, allowing the skin to heal.
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Another treatment option – called photodynamic therapy – uses a sun-sensitizing chemical to remove this type of growth from the skin.
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Dermatologists now also have five main topical creams used in management of solar keratoses, the first three of which in the list below have been formally approved by the Food and Drug Administration as being effective for treatment of solar keratoses:
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fluorouracil cream (Efudex® Cream and Fluoroplex® Cream) – a chemotherapy agent that’s been used internally for many years:
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imiquimod cream (Aldara® Cream), an agent that works on the immune responses of the skin, and
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Klysiri Ointment® (Tirbanibulin oinitment) is a new topical product that seems to work with only a five days course for areas of the face and neck.
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tretinoin cream (also called Retin® A Cream and Renova® Cream) – a vitamin A chemical, and
5. Alpha hydroxy acid creams (AHAs) – many of which were originally discolored in milk, fruits, and sugarcare. AHAs include Glycolic Acid, which has the side-benefit of improving the appearance of fine lines in the skin and helping with mottled skin pigmentation, improving surface texture. Big River Silk Skincare Inc., a company of which I am the President, manufactures and distributes several antiwrinkle creams and lotions:
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GlycoShea™ Facial&Neck Lotion/Standard Strength
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GlycoShea Facial&Neck Lotion/High Strength
GlycoShea™ Hand&Body Cream/Standard Strength
GlycoShea Hand&Body Cream/High Strength
GlycoShea™ Facial&Neck Cream,
GlycoShea Facial&Neck Oil/Standard Strength
GlycoShea Facial&Neck Oil/High Strength.
All of these GlycoShea products are produced by Big River Silk Skincare Inc. in Memphis, TN.
​They are available either on-site at Big River Silk skincare’s headquarters, at 8143 Walnut Grove Road, Cordova TN 38018, or they can be ordered through www.Rheumderm.com ($5.00 shipping and handling charge for orders under $40.00 ($10.00 Canadian orders; free shipping and handling for orders above $40.00).
So if you or a family member has a skin lesion that has changed color or size, or which won’t heal, particularly one that is rough, my own Memphis Dermatology practice is at Rheumatology and Dermatology Associates, 8143 Walnut Grove Road, Cordova TN 38018. 1-901-753-0168. Or you can find a Dermatologist closer to you by going to the American Academy of Dermatology web site, www.AADA.org, then plugging your zip code into the “Find a Dermatologist tab.” You’ll get a list of Dermatologists in your immediate area.