When It’s More Than Just An Age Spot . . .

age_spot_analysisI am asked daily to evaluate multiple areas of the skin with one of the common questions being, “Is this just an age spot?”  And frequently, it is.  Occasionally, however, I do have to stop and examine an area more closely and say, “That is more than just an age spot.”

While it is good these days for people to look out for and be concerned about skin cancer, you shouldn’t panic if you see an age spot.  Although I do see a spot or lesion that is clear to me to be a type of skin cancer, much more common is a precancerous lession called an actinic keratosis.

The word actinic means derived from the effects of ultraviolet light such as the sun and UV lamps.  Keratosis means development of rough, scaly patch of skin.  These lesions are also sometimes called solar keratosis.

These lesions are very common in the most sun exposed skin surfaces.  They are also more common in light or fair complexioned people.

They tend to be as a result of chronic exposure to UV light, so they are more common in older age groups.  Unfortunately, with the advent (and to me, bizarre popularity) of tanning beds over the past several decades, I am seeing more of these lesions even in the 30-50 year old ages.

Of most concern beyond their cosmetic appearance is that a small percentage of 5-10% (depending on the studies reviewed of these lesions) develop into skin cancers, specifically squamous cell carcinoma.  I frequently make the analogy to colon polyps in that only a small percentage ever develop into cancer, but as a form of prevention, they should be treated or removed when seen and identified.

actinic_keratosisThe actinic keratosis (or AK as it sometimes abbreviated) is usually flat or slightly raised.  It can be pink in early stages but more commonly it is brown or tan with a scaly texture.

Most common locations include the face, ears, neck and back of the hands.  They can begin very slowly over a number of years.

Sometimes, the areas involved can be more sensitive than adjacent skin, but generally they are painless.  This condition can run in families, but this may be more due to inheritance of fair complexion rather than a specific genetic defect.

Over the years, many treatments have been used to eliminate these precancerous areas. Cryotherapy with liquid nitrogen is a common choice, and I perform that procedure at times.

Laser ablation also works also by destroying the AK cells with the concentrated beam of the laser heating the tissue.  Surgical removal is sometimes necessary depending on the size and location.

Surgery is most indicated if I am concerned that the spot has already made the transition to skin cancer and requires a biopsy evaluation.  Topical chemotherapy with fluorouracil also works, especially if someone has multiple areas.

Anyone who is treated for actinic keratoses needs to be religious about sunscreen and sun avoidance so as not to aggravate the tendency to develop these lesions.  I also recommend that people with this diagnosis have an examination of the treated and other exposed areas every 6-12 months.  This will insure that the treated lesions do not recur, and monitor for any new lesions caused by the previous lifetime of sun exposure.

If you or anyone about whom you are concerned have these kinds of spots, please do not hesitate to call for a free consultation.  I can give you my evaluation and formulate a plan of action including a referral to a more specialized physician if I cannot treat the lesions with my methods and equipment.  As always, wearing sunscreen as a daily habit is the best preventive medicine and most cost-effective as well.

About Dr. John Burke

John Burke M.D. has practiced medicine for over 25 years, and is the founding partner of MidMaine Internal Medicine. He established Maine Laser Skin Care in 2004 after devoting years to learning the latest in laser and dermatologic technology. Dr. Burke has treated patients from all over the United States. He is one of Maine's busiest practitioners in laser treatments, and in the use of Botox for upper facial lines and excessive sweating.
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