What happens to the skin
Ultraviolet light damages the DNA of epidermal cells. The body corrects isolated mistakes, but the damage accumulates over the years, and at some point the cells in a particular area stop maturing correctly. They divide randomly and produce an excessive amount of horny substance - hence the rough scales on the surface. As long as the altered cells remain within the top layer of skin, it is actinic keratosis. If they grow deep through the basement membrane, the diagnosis changes to squamous cell carcinoma. Often all the surrounding skin is also changed, and doctors talk about the field of damage.
- Damage to cell DNA from accumulated ultraviolet radiation
- Impaired maturation of cells in the upper layer of skin
- Excessive formation of horny substance
- Transition to squamous cell carcinoma when growing deeper
- Damage field - altered skin around visible lesions
Who's at risk
The main factor is the total dose of sun over a lifetime, so most often outbreaks are found in people over fifty who worked a lot on the street: builders, farmers, drivers, fishermen. Fair skin, blond or red hair, blue eyes and a tendency to burn instead of tan significantly increase your risk. Tanning beds are also dangerous. A separate group is people with weakened immune systems, primarily after organ transplantation: their lesions appear earlier, there are more of them, and they are more likely to degenerate. Men with early baldness are vulnerable due to an unprotected scalp.
- Light skin prone to burns
- Outdoor work
- Age over 50
- Visiting solariums
- Taking drugs that suppress the immune system
- Baldness and lack of headwear
What it looks like and where it appears
The lesion is usually small, from a few millimeters to a centimeter, pinkish, reddish or skin-colored, with a dry, rough surface. Characteristic feature: when touched, it is felt more clearly than visible to the eye, and when you try to remove the scale, it is difficult to separate and leaves a sensitive surface. The lesions are usually multiple and located in open areas. On the lips there is a separate form - actinic cheilitis, in which the red border becomes dry, pale, with an unclear border. Sometimes a dense horny growth forms on the skin.
- Rough spots that are easier to feel
- Pink, reddish or flesh color
- Dense scale, difficult to separate
- Face, ears, bald head, nose, back of hands and forearms
- Multiplicity of foci
- Actinic cheilitis on the lower lip
Diagnostics
An experienced dermatologist will recognize a typical lesion upon examination by assessing the appearance and characteristic sandpaper feel under the fingers. Dermatoscopy increases accuracy: with actinic keratosis, a peculiar structure in the form of pink fields is visible around the mouths of the hair follicles. A biopsy with histological examination is needed when the lesion is dense, elevated, ulcerated, or cannot be treated—that is, when squamous cell carcinoma cannot be ruled out. The doctor examines the entire skin, since the lesions are almost always multiple, and other skin tumors are often found in one person.
- Examination of the entire skin, not just the disturbing area
- Evaluation of characteristic roughness by touch
- Dermatoscopy
- Biopsy with histology for suspected cancer
- Excision of formation with histological examination
- Regular monitoring for multiple lesions
Treatment and sun protection
Single lesions are usually removed by destructive methods: cryodestruction with liquid nitrogen, less often with laser or curettage. When there are many lesions and the entire area is changed, external medications are used in a course that affects the entire field of damage, as well as photodynamic therapy. Dense and suspicious formations are excised with mandatory histological examination. The specific method is chosen by the doctor. Daily sun protection is equally important: without it, new lesions will appear again. You cannot cut, burn or peel off the scabs yourself - this will result in the loss of the opportunity to recognize cancer in a timely manner.
- Cryodestruction with liquid nitrogen
- External preparations for treating the damage field
- Photodynamic therapy
- Laser removal and curettage
- Excision with histology for suspected cancer
- Daily sunscreen, brimmed hat, long sleeves
