Actinic keratosis, also known as a pre-cancer, is a skin growth that results from excessive cumulative sun exposure. Lesions are often pink, red, or tan and feel rough, like sandpaper. Although the risk of transformation to skin cancer—typically a squamous cell carcinoma—is estimated to be relatively low, the presence of multiple or diffuse actinic keratoses significantly increases such risk.
What Are Actinic Keratoses?
Actinic keratoses are pre-cancerous skin growths caused by chronic sun exposure. They commonly appear on sun-exposed areas and may feel rough or scaly, often resembling sandpaper.
While individual lesions may carry a relatively low risk of progression, patients with multiple or widespread actinic keratoses have a higher overall risk of developing squamous cell carcinoma.
Prevention and Treatment Options
Patients with actinic keratoses require strict sun protection using broad-spectrum UVA/UVB sunblocks and sun-protective clothing to reduce the number of new lesions and help limit malignant transformation within existing lesions.
Existing lesions should also be treated with one of several modalities available today. These may include cryosurgery (freezing), topical chemotherapeutic agents, and photodynamic therapy (PDT).
Photodynamic Therapy (PDT)
Photodynamic therapy is an in-office procedure that utilizes a combination of a topical light-sensitizing agent known as aminolevulinic acid (ALA) and a light source to activate this agent.
PDT is used to treat a variety of skin conditions, most notably actinic keratoses, but also acne, sun damage, and others. After the chemical is applied to the skin, it is allowed to penetrate into the deeper layers, where it is preferentially picked up by pre-cancerous cells in actinic keratoses or oil glands in the case of acne.
How PDT Works and What to Expect
Subsequent exposure to light from a light source, such as blue light, activates the chemical and leads to the destruction of pre-cancerous cells. Because all pre-cancerous cells and only pre-cancerous cells are destroyed, this treatment is especially effective in cases of diffuse actinic keratoses, affording a field treatment.
Though mild to moderate stinging or burning may be experienced during treatment, this therapy is generally well tolerated. Mild pinkness or redness akin to a sunburn reaction is common after treatment, often followed by mild peeling for several days. Swelling or crusting may also occur, especially in the presence of large pre-cancerous lesions.
Aftercare and Insurance Coverage
Due to temporary persistence of ALA in the skin, it is critical to avoid direct or indirect sunlight following PDT for at least 24 hours to prevent sunburn. Sun protection with a broad-spectrum sunblock is utilized thereafter.
This procedure is covered by most insurance plans, including Medicare, for the treatment of actinic keratoses. However, it is not covered for all other indications, including acne. In such cases, procedure fees will be discussed during consultation.
Frequently Asked Questions
Are actinic keratoses skin cancer?
Actinic keratoses are considered pre-cancerous lesions. They are not skin cancer themselves, but some can progress to squamous cell carcinoma over time.
What does photodynamic therapy treat?
Photodynamic therapy is most commonly used to treat actinic keratoses, but it may also be used for other conditions such as acne and certain types of sun damage.
Is photodynamic therapy painful?
Mild to moderate stinging or burning may occur during treatment, but the procedure is generally well tolerated.
Is PDT covered by insurance?
Most insurance plans, including Medicare, cover photodynamic therapy for the treatment of actinic keratoses. Coverage does not usually apply to all other indications, such as acne.
If you would like to find out more about the treatment of actinic keratoses or photodynamic therapy, or would like to schedule a personal consultation with Dr. Berlin, please contact our office today.