Solar Keratoses (Sunspots)

 

What are Sunspots? 

Sunspots (solar keratoses, actinic keratoses) are premalignant skin lesions ie. may turn into skin cancer at a later time. They are caused by excessive long-term sun exposure. They are seen as relatively flat, scaly, and often red areas on sun-exposed skin. The sun exposure causing your sunspots may have occurred many years prior to their appearance. You don't need to have recent sun exposure to get sun spots!

Actinic keratosis (AKs) typically present as scaly, erythematous papules (bumps) or rough patches on sun-exposed areas and are the most common precancerous skin lesions.

 

 

 

 

 

 

 

 

 

Why do they need treatment? 

While sunspots are not cancerous they can turn into skin cancer (squamous cell carcinoma) and despite the potential for a single sunspot to turn cancerous being low, the more you have the more likely you are to get skin cancer. Treatment is necessary because approximately 2 to 15% of lesions may progress to non- melanoma cutaneous skin cancer (NMSC). Once skin cancer has arisen from a sunspot the lesion usually requires surgical excision.

How are they treated? 

The treatment involves only superficial destructive procedures. The most common treatment is cryotherapy. This therapy involves liquid nitrogen freezing which results in destruction of the top layer of your skin - the epidermis. There are also some creams which are effective in removing sunspots and light therapy. Therapy is determined by location (face, scalp, forearms, or legs) and extent (few vs multiple). The three strategies for treatment that are commonly used are described below:

  1. Physical destruction (such as liquid nitrogen therapy)

  2. Topical chemotherapy (5-fluorouracil, imiquimod, ingenol mebutate or diclofenac)

  3. Light therapy (such as photodynamic therapy (PDT) and day light PDT)

 

Liquid nitrogen therapy

  • Some patients may experience redness, swelling, blistering, pain, or scab formation at sites of liquid nitrogen therapy that may last for 3 to 5 days after treatment. Make-up should be avoided at this stage.

  • Treated areas should be covered with non-medicated ointment (petrolatum or Cicalfate®) until all signs of treatment-related inflammation are resolved. Gently wash with water and soap. Avoid sun exposure.

 

Topical treatment (5- fluorouracil, imiquimod, ingenol mebutate or diclofenac)

  • Follow your doctor’s instructions on how to apply the cream, including: where to apply the cream, how many times a day to apply the cream and the length of treatment.

  • Some patients may experience redness, swelling, blistering, pain, or scab formation at treated areas that may last for 3 weeks after treatment.

  • After the treatment course is completed, red and/ or inflamed areas may benefit from application of a non-medicated ointment (such as petrolatum or Cicalfate®) or a medium-strength topical steroid ointment (such as hydrocortisone or mometasone) for 3-7 days. Consult your doctor for advice on skin care following your treatment.

  • Topical treatments for actinic keratosis often increase sun sensitivity and risk for sunburn. It is important to avoid the sun during the treatment as well as for several weeks afterwards (see below).

  • Some patients may have persistent redness (faint pink) and slight tenderness for 3 to 6 months following the treatment. Moisturize to help your skin recover.

 

Light therapy (such as photodynamic therapy (PDT) and day light PDT)

  • PDT is a treatment that uses special drugs, called photosensitizing agents, along with light to destroy cancer cells. The drugs only work after they have been activated by certain wavelengths of light. 

Prevention: Sunscreen and photoprotection

  • Many patients experience increased sensitivity to sun exposure after treatment of actinic keratosis.

  • Regular sunscreen use may prevent the recurrence of actinic keratoses.

  • Avoid the sun during its peak hours (typically 10 am to 2 pm) and consult your doctor for advice on how to choose and apply sunscreen, as well as for other tips for photoprotection (such as hats, gloves, and protective clothing).

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