eratoses are tumors of the skin that occur in most people in the latter decades of life.
There are two kinds of keratoses, the most common being the harmless seborrheic keratoses. These are light brown, greasy, slightly raised growths that chiefly involve the face, chest, and back. They are slow-growing, loosely attached to the skin, and are usually covered by a waxy-looking crust that appear to have a pasted-on appearance. They may be single or multiple and are usually round or oval, although they may appear in any shape. They vary in size from a fraction of an inch in diameter to up to half-dollar size or larger.
Some dermatologists call these “delayed birthmarks”; others are not so kind and refer to them as the “barnacles of old age.” I now refer to them as the “barnacles of maturity.”
Seborrheic keratoses appear to run in families. Unlike moles, they become more common and more numerous with advancing age. They are not infectious or contagious, and they never become malignant. And they cannot be prevented. Many people are fond of scraping these warty growths off with their fingernails – a habit that I do not recommend. They may become infected, and they invariably grow back if not completely destroyed. There are no internal remedies – either curative or preventive – and no salves or ointments that will rid a person of these warty growths. For cosmetic reasons, some people choose to have them removed.
Actinic keratoses, on the other hand, are very early skin cancers. And the offender in all cases are the harmful rays of the sun. Also called solar keratoses, these tumors usually arise over the sun-exposed portions of the body – face, ears, forearms, neck, bald scalp, and backs of hands – and are commonly found in fair-haired, blue-eyed, fair-skinned people habitually exposed to the sun: the farmer, the sailor, the fisherman, the cattleman, the lifeguard. More than 100,000 new cases of actinic keratoses are diagnosed annually. Black people rarely develop actinic keratoses.
These tumors are rough, dry, reddish-brown, dirty-looking growths that are firmly planted in the skin surface. If not treated, some of these may, after many years, undergo serious malignant degeneration – in other words, become cancerous. When this happens, there is the danger of the disorder spreading to lymph glands and internal organs. Therefore, it is advisable to have these tumors removed before they degenerate into malignant lesions.
Your physician can remove both types of keratoses by any of the following methods:
- Electrosurgery. After the lesion has been anesthetized, the physician burns it with an electric current and then scrapes it off with a round knife (dermal curette). Bleeding is insignificant, and the entire procedure takes but a few minutes. Depending upon the depth of the lesion, only minimal scarring results.
- Curettage. Following a local anesthetic, the lesion is scraped off in the same manner as described above, except there is no burning. Very small lesions may be destroyed by this method even without anesthesia, but this procedure is usually reserved for stoics.
- Liquid nitrogen cryotherapy. Considered the “gold standard” for the treatment of keratoses, this extremely cold substance (minus 320° F) is applied to the keratoses for a few seconds with a cotton applicator or a spray-type device. Over the next few days, the areas blister and the lesions become raised. They subsequently dry up and fall off. There is only minimal discomfort, and the cosmetic results are excellent. No scarring results from this method.
A physician can treat a dozen or more of these tumors by any of these methods (depending upon the size and location) without great inconvenience to the patient.
In addition, there is a chemical substance – 5-fluorouracil (5FU) – which, when locally applied for a period of a month or two, selectively picks out the “disagreeable” cells of the more sinister actinic keratoses. This 5FU – a self-administered topical treatment – produces a moderately severe reaction in the skin for a few weeks. Then, after the process has reached its peak, the areas slowly heal, leaving the skin smooth and soft – with no scarring. Dermatologists often recommend this procedure for multiple actinic keratoses, particularly about the face and scalp. (5FU has no effect on seborrheic keratoses.) There are three brands of this topical 5-FU: Efudex, Fluoroplex, and Carac. All are prescription products.
A new system for the treatment of actinic keratoses is the Levulan Kerastick. This combines the application of a topical photosensitizer (aminolevulinic acid), in a “stick” form, with “blue light.” Your dermatologist will be able to explain and discuss the various ramifications of this innovative therapy.
Yet a new topical treatment has been touted. This cream – Aldara – has proven to be effective in the management of actinic keratoses, not the seborrheic kind.
Other therapies involve full-face laser resurfacing; chemical peels; and the self-administered application of such diverse chemicals as alpha-hydroxy acids, Retin-A, Differin Gel and a whole host of other “cosmeceuticals” which have flooded the market. If you are confused, ask your dermatologist.
For those with a tendency to develop actinic keratoses – the fair-haired, blue-eyed, fair-skinned individuals – it is extremely important to avoid the sun. If your occupation – or hobby – requires sun exposure, always use a sunscreen with a sun-protection factor (SPF) of at least 15.
For more information on keratoses, log on to:
www.aad.org
or phone:
1-888-462-DERM x22
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RECAP
- Seborrheic keratoses become more common and more numerous with advancing age. They are not infectious or contagious, and they never become malignant.
- Actinic keratoses are very early skin cancers.
- For those with a tendency to develop actinic keratoses – the fair-haired, blue-eyed, fair-skinned individuals – it is extremely important to avoid the sun.
