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Actinic Keratosis: Pre-cancer
An actinic keratosis (AK) is a rough, dry, scaly patch or growth that forms on the skin. An AK forms when the skin is badly damaged by ultraviolet (UV) rays from the sun or indoor tanning.
PDT is FDA-approved for the treatment of superficial or nodular BCC, with cure rates ranging from 70 to 90 percent. A light-sensitizing agent, topical 5-aminolevulinic acid (5-ALA), is applied to the lesion in the physician’s office. Subsequently, the medicated area is activated by a strong blue light; theoretically, this will selectively destroy BCCs while causing minimal damage to surrounding normal tissue. Some redness, pain, and swelling can result. Patients must strictly avoid sunlight for at least 48 hours, or UV exposure may further activate the medication, causing severe sunburn.
Doctors may combine therapies for a period of time to treat AKs. Typically, treatment regimens combine cryosurgery with PDT or a topical agent like imiquimod, diclofenac, ingenol mebutate, or 5-fluorouracil (5-FU). The topical medications and PDT may also be used alternately every three months, six months or year, as determined by the physician at follow-up skin examinations.
If you have numerous or widespread actinic keratoses, your doctor may prescribe a topical cream, gel or solution. These can treat visible and invisible lesions with a minimal risk of scarring. Doctors sometimes refer to this type of therapy as “field therapy,” since the topical treatments can cover a wide field of skin as opposed to targeting isolated lesions.
- 5-fluorouracil (Carac®, Efudex®, Fluoroplex®): a form of topical chemotherapy.
- Imiquimod (Aldara®, Zyclara®): A form of topical immunotherapy, it stimulates the immune system to produce interferon, a chemical that attacks cancerous and precancerous cells.
- Ingenol mebutate (Picato®): A rapidly effective topical therapy derived from plants. An immunologic mechanism of action has been proposed.