Actinic Keratoses: Laser and Precancerous Sun Damage

Actinic keratoses are rough, scaly patches caused by long-term sun damage, and a small proportion can develop into a type of skin cancer called squamous cell carcinoma. Because of that, they are a medical concern first and a cosmetic one second. Diagnosis and standard treatment by a physician come before anything else; laser resurfacing may play a supporting role for some people with widespread sun damage, but it is not the starting point.

What actinic keratoses look and feel like

They often feel like sandpaper before they are easy to see. Common features include:

• A dry, rough or gritty patch, often a few millimetres to a centimetre across
• Pink, red, skin-coloured or light brown colour, sometimes with a scaly crust
• A tendency to come and go, or to catch on a towel or razor
• Locations that get the most sun: the face, ears, scalp (especially with thinning hair), lips, backs of hands and forearms

They are most common in people with fair skin, those over 40, people who have spent years working or playing outdoors, and anyone whose immune system is suppressed. In Cape Breton, years of fishing, farming, construction, boating and summer days on the beach all add up.

Why they matter

An actinic keratosis is a sign that skin cells have been damaged by ultraviolet light. Most do not turn into cancer, and some fade on their own, but it is not possible to tell reliably by looking which ones will progress. Having several also signals that the surrounding skin has had significant sun exposure, which raises the overall chance of other skin cancers.

Some skin cancers can look very similar, especially early squamous cell carcinoma and some basal cell carcinomas. A spot that is thick, tender, growing quickly, bleeding or not healing needs prompt medical attention.

Diagnosis comes first

If you notice rough, scaly spots, the first step is to see your family doctor or a dermatologist. Diagnosis is often made by examining the skin, sometimes with a magnifying light. A biopsy may be recommended if a spot looks atypical, is thickened or does not respond to treatment.

A cosmetic clinic visit is not a replacement for this assessment. At a laser consultation, any suspicious spot should be identified and referred for medical review before treatment is considered. For a broader overview of warning signs, see our article on checking moles and spots.

Standard medical treatments

Your physician will choose a treatment based on how many spots you have, where they are and your overall health. Well-established options include:

• Cryotherapy: freezing individual spots with liquid nitrogen, often in the doctor's office
• Prescription creams: such as fluorouracil, imiquimod and others, used to treat a wider area of sun-damaged skin. These commonly cause a period of redness and crusting
• Photodynamic therapy: a light-sensitising medicine is applied to the skin and then activated with a specific light source
• Scraping or surgical removal for thicker or uncertain spots

These treatments are prescribed and supervised by a physician. Use any prescription cream exactly as directed, and discuss side effects with the prescriber rather than stopping or changing treatment on your own.

Where laser resurfacing may fit

Ablative lasers, such as the erbium (Er:YAG) wavelength available on the Fotona system, remove a thin layer of the skin surface. As the skin heals, it is replaced by new cells. Research suggests that ablative resurfacing can reduce the number of actinic keratoses in a treated area for a period of time, and some dermatologists use laser in combination with photodynamic therapy.

The evidence has limits. Studies vary in technique and follow-up length, and new keratoses commonly develop over time because the underlying sun damage has not gone away. Laser has not been shown to be better than standard treatments for actinic keratoses, and it is generally used as a complement, not a replacement.

In practical terms, laser resurfacing may be worth discussing if you have widespread sun damage, your physician has already diagnosed and treated your actinic keratoses, and you also want to improve texture, brown spots or fine lines. Coordination with your family doctor or dermatologist is important. Our article on laser skin resurfacing explains the procedure.

Who should not have laser for this, or should wait

Laser should not be used over a spot that has not been diagnosed, a spot suspected to be skin cancer, or skin actively being treated with a prescription cream until your physician agrees healing is complete. Treatment is also usually postponed with active infection, cold sores near the area, recent sunburn, pregnancy or recent isotretinoin use. People with poorly controlled diabetes, immune suppression or a history of keloids need extra caution and input from their treating physician.

The main risks of resurfacing include redness and swelling, oozing and crusting, infection, cold sore outbreaks, pigment changes and, rarely, scarring. Recovery is longer for deeper treatments and for older or thinner skin.

Prevention is still the main treatment

Daily broad-spectrum sunscreen of SPF 30 or higher, a wide-brimmed hat, lip protection with SPF and avoiding midday sun reduce the number of new keratoses over time. Regular skin checks with your doctor are wise if you have had actinic keratoses or skin cancer before.

Between visits, it helps to look over your face, ears, scalp, hands and forearms every month or two, ideally with a mirror or a partner's help. Note new rough spots or changes in existing ones, and take a photo if it helps you track them.

Frequently asked questions

Can I pick or scrub off a rough patch?

No. It usually returns, and picking can cause bleeding, infection or scarring. Have it assessed instead.

Will laser stop new keratoses forming?

Not reliably. It may reduce them for a time in the treated area, but new ones can still appear, so sun protection and checks remain important.

Is an actinic keratosis the same as skin cancer?

No. It is considered precancerous, meaning a small proportion may progress. That is why a medical assessment matters.

If you have sun-damaged skin and have already had your spots assessed by your doctor, HealthPark Medical Aesthetics can discuss at a consultation whether laser might complement your medical care.