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St. Louis Pre-Cancer Treatment

Close-up image showing rough, scaly patch on the skin, indicative of actinic keratosis

Got rough, scaly patches on your skin? You might be dealing with actinic keratosis (AK), a common condition caused by sun damage and UV exposure. If these lesions are left untreated, however, these seemingly harmless lesions can transform into squamous cell carcinoma, a malignant form of skin cancer. At Mid-County Dermatology, our St. Louis dermatologists, Dr. Feigenbaum and Dr. Gibstine, perform skin cancer screenings to identify actinic keratoses and treat them early before this transformation happens. If you have not had a skin cancer screening, call or text 314-994-0200 to schedule your skin check. Alternatively, you can schedule online.


What are actinic keratoses?

Actinic keratoses (also known as solar keratoses) are pre-cancerous skin lesions that mainly occur on sun-exposed areas like the face and hands, increasing the risk of skin cancers. AK lesions often appear as crusting or scaly patches, so sometimes they are better felt than seen.

Top Factors for Pre-Cancerous Skin 

Understanding the risk factors associated with actinic keratoses can help patients take proactive steps to prevent and manage this scaly patch condition. Here are some key factors that contribute to the likelihood of developing actinic keratoses.

1. Fair skin

People with fair skin have less melanin, which makes them more susceptible to sun damage and an increased risk of developing actinic keratoses. The lack of melanin allows UV radiation to penetrate the skin more easily, leading to cellular changes and the development of these precancerous lesions. Fair-skinned individuals should be vigilant about protecting themselves from the sun's harmful rays to prevent malignant transformation.

2. History of excessive sun exposure or tanning bed use

Excessive exposure to UV rays is one of the primary causes of actinic keratoses. Spending long hours under the sun without adequate protection or using tanning beds regularly increases the risk of lesions significantly. Tanning beds emit concentrated levels of UV radiation, which can be even more damaging than natural sunlight. Individuals who frequently engage in outdoor activities or professions that involve prolonged sun exposure should take extra precautions to protect their skin from malignant transformation.

3. Age and a weakened immune system

As we age, our skin becomes less resilient and more vulnerable to environmental factors such as UV radiation. Older adults often have accumulated years of sun exposure, making them more prone to developing actinic keratoses. A weakened immune system due to certain medical conditions or medications can compromise the body's ability to repair damaged cells efficiently, further increasing the risk of malignant transformation.

By being aware of the risk factors associated with actinic keratoses and taking proactive steps to protect the skin from lesions, individuals can reduce their chances of developing this condition. Prevention is key. Remember, protecting your skin today can help you avoid potential problems with AKS in the future.

Symptoms of Actinic Keratosis

The symptoms of actinic keratosis include:

  1. Red or brown patches: Actinic keratoses typically appear as scaly patches that range in color from red to brown. These patches may be flat or slightly raised and can vary in size. 

  2. Roughness: The affected areas often feel rough or gritty when touched due to the buildup of excess skin cells caused by UV damage. 

  3. Itching and/or tenderness: In some cases, actinic keratoses may cause itching or a burning sensation. If scratched excessively, these lesions can become inflamed and tender.

How St. Louis Dermatologists Diagnose Pre-Cancer

Our St. Louis dermatologists at Mid-County Dermatology typically diagnose actinic keratosis (AKs) through visual examination. By carefully inspecting the affected areas of the skin, they can identify the characteristic signs and symptoms associated with this condition. AKS often presents as rough, scaly patches on sun-exposed areas such as the face, scalp, ears, neck, arms, and hands.

During a visual examination, our dermatologists may use a magnifying instrument called a dermatoscope to get a closer look at the affected skin and assess the texture and color changes indicative of actinic keratosis. They rely on their clinical expertise to differentiate AKs from other similar skin conditions.

In some cases where there is uncertainty about the diagnosis or if the lesions are atypical in appearance, a biopsy may be performed to confirm whether actinic keratosis is present. A biopsy involves removing a small sample of tissue from the affected area for further analysis under a microscope. This allows dermatopathologists to examine the cells in detail and confirm the presence of AKs.

Regular skin checks are crucial for early detection and treatment of AKs. Our St. Louis dermatology team recommends performing self-skin exams at least once a month to monitor for any changes or new growths on your skin. It's important to pay close attention to areas frequently exposed to sunlight and inspect them thoroughly using mirrors or by asking someone for assistance.

During these skin exams, keep an eye out for any rough or scaly patches that feel like sandpaper when touched. Actinic keratosis (AKs) lesions can range in color from pink to red and may have an uneven surface resembling warts or crusty bumps.

If you notice any concerning skin changes during a self-exam, it's crucial to seek medical attention promptly. Our dermatologists will be able to evaluate the suspicious area and determine whether further investigation or treatment is necessary.

St. Louis Pre-Cancer Treatment: Your Options

There are various options available depending on the severity of the condition. Some common treatment options include:

  1. Topical Creams: these creams contain ingredients such as imiquimod or fluorouracil (see next section below). These creams are applied directly to the affected area and work by targeting abnormal cells, gradually eliminating them.

  2. Procedures: In more severe cases, procedures may be required for effective treatment. Some commonly used procedures include:

    • Cryotherapy: This involves freezing the affected areas with liquid nitrogen, causing the damaged cells to blister and eventually fall off.

    • Photodynamic Therapy (PDT): A photosensitizing agent is applied topically to the affected area, followed by exposure to light that activates the agent and destroys abnormal cells.

    • Shave Excision: In certain cases, surgical removal of actinic keratoses may be necessary.

Fluorouracil Cream and Imiquimod Cream for Actinic Keratosis

Fluorouracil Cream

Fluorouracil cream, also known as 5-FU cream, is a topical medication that selectively destroys abnormal cells in actinic keratoses. It works by inhibiting the growth of rapidly dividing cells, which are characteristic of these precancerous lesions. When applied to the affected area, fluorouracil penetrates the skin and interferes with DNA synthesis in abnormal cells.

Consistent application of fluorouracil cream over several weeks is essential for optimal results. During this time, patients may experience redness, itching, and crusting at the application site as the abnormal cells are destroyed. These side effects are temporary and indicate that the medication is working effectively.

Imiquimod Cream

Imiquimod cream takes a different approach to treating actinic keratosis. Instead of directly targeting abnormal cells, it stimulates the immune system to recognize and eliminate them. Imiquimod activates toll-like receptors on immune cells, triggering an immune response against actinic keratosis cells.

Similar to fluorouracil cream, imiquimod requires consistent application over several weeks for optimal outcomes. Patients may experience local skin reactions such as redness, swelling, and flaking during treatment. These reactions indicate that the immune system is actively working to clear away actinic keratosis lesions.

Cryotherapy and Photodynamic Therapy

Cryotherapy and photodynamic therapy are two effective treatment options for actinic keratosis. Each method utilizes different techniques to target and eliminate the abnormal cells caused by prolonged exposure to ultraviolet (UV) radiation.


Cryotherapy involves freezing actinic keratosis lesions with liquid nitrogen to induce their removal. Liquid nitrogen is extremely cold and capable of destroying abnormal cells upon contact. During cryosurgery, our dermatologists use a cotton swab or spray device to apply liquid nitrogen directly onto each lesion.

The freezing process causes localized inflammation and blistering around the treated area. Over time, these blisters form crusts that eventually slough off, revealing healthy skin underneath. Multiple cryotherapy sessions may be necessary depending on the extent of actinic keratosis present.

Cryotherapy offers several advantages such as its ability to treat multiple lesions simultaneously and its relatively low risk of scarring. However, it can cause temporary discomfort during the freezing process and may result in hypopigmentation or hyperpigmentation in some individuals.

Photodynamic Therapy

Photodynamic therapy (PDT) is a treatment that combines a photosensitizing agent with light exposure to kill abnormal cells. The process involves applying a topical medication containing the photosensitizer to the affected skin. After a specified incubation period, the area is exposed to a specific wavelength of light, activating the medication and destroying the targeted cells.

PDT is particularly useful for treating widespread actinic keratosis or areas where other treatments may be challenging to apply. It offers an advantage over other methods as it can treat both visible lesions and those not yet apparent on the surface of the skin.

Following PDT, patients may experience redness, swelling, and peeling in the treated area. Sun protection is crucial after this procedure as the photosensitizing agent makes your skin more sensitive to sunlight.

Living with Pre-Cancer: St. Louis Skin Health

Actinic keratosis is a common skin condition that primarily affects individuals with a history of prolonged sun exposure. While most actinic keratoses are benign, they have the potential to progress into squamous cell carcinoma, a type of skin cancer, if left untreated. Therefore, early detection and treatment are crucial in improving the prognosis for individuals with actinic keratosis.

Regular monitoring of the skin is essential for patients diagnosed with actinic keratosis. This allows healthcare providers to identify any recurrence or new lesions promptly. By closely monitoring the affected areas, healthcare providers can intervene at an early stage before the condition progresses further.

Our St. Louis dermatology team recommends that patients who have been diagnosed with actinic keratosis should maintain regular follow-up appointments with their dermatologist. These visits provide an opportunity for a thorough examination of the skin and ensure timely intervention if any changes are detected.

One of the key factors affecting the outcome of actinic keratosis is patient compliance with treatment plans. Dermatologists often prescribe topical medications for daily application on affected areas. Adhering to these treatment regimens significantly improves the chances of successful resolution and prevents progression to squamous cell carcinoma.

In addition to adherence to prescribed treatments, taking preventive measures is crucial for individuals with actinic keratosis. Limiting sun exposure by staying indoors during peak hours and wearing protective clothing can help minimize further damage to the skin.

Moreover, it is important for patients diagnosed with actinic keratosis to be proactive in their care. If they notice any new lesions or changes in existing ones, they should immediately reach out to their dermatologist. Timely communication ensures that appropriate action can be taken promptly.

While actinic keratosis has the potential to progress into squamous cell carcinoma if left untreated, it is important not to panic. The majority of cases can be effectively managed when detected early and treated appropriately. By closely following the recommendations of healthcare providers and maintaining regular check-ups, individuals with actinic keratosis can improve their prognosis and minimize the risk of complications.

Prevention of Actinic Keratosis

Actinic keratosis is a common skin condition caused by excessive sun exposure. By taking proactive measures to protect our skin and educating patients about the risks, we can significantly reduce the incidence of actinic keratoses.

Sun protection measures play a crucial role in preventing actinic keratosis development. Wearing hats that provide shade for the face and neck can shield our skin from harmful ultraviolet (UV) rays. Using sunscreen with a high SPF rating and broad-spectrum protection is essential. Patients should be encouraged to apply sunscreen generously before going outdoors and reapply every two hours or after swimming or sweating excessively.

Seeking shade whenever possible is another effective way to minimize sun damage. Whether it's finding shelter under trees or using umbrellas at the beach, reducing direct exposure to sunlight can greatly decrease the risk of developing actinic keratoses.

Tanning beds have gained popularity in recent years, but they pose significant dangers to our skin health. Educating patients about the risks associated with artificial tanning is paramount. Highlighting the fact that tanning beds emit UV radiation similar to sunlight can help deter individuals from engaging in this harmful practice.

In addition to sun protection measures, regular skin checks are crucial for early detection of actinic keratoses. Educating patients about the importance of self-examination and encouraging them to seek professional dermatological evaluations can make a significant difference in preventing the further progression of this condition.

Lifestyle modifications also play an important role in minimizing sun damage and reducing the incidence of actinic keratoses. Encouraging individuals to adopt healthier habits such as limiting outdoor activities during peak sunlight hours (10 am - 4 pm), wearing protective clothing like long sleeves and pants, and using wide-brimmed hats will provide an extra layer of defense against harmful UV radiation.

Actinic Keratoses: How St. Louisans Should Protect Their Skin 

Actinic keratosis is a common skin condition that affects many individuals. It is important to be aware of the risk factors, symptoms, and warning signs associated with this condition to seek a timely diagnosis and appropriate treatment.

Individuals who spend long hours under the sun or have fair skin are more susceptible to developing actinic keratoses. Such individuals must take necessary precautions and protect their skin from harmful UV radiation.

Recognizing the symptoms and causes of actinic keratosis can help in early detection and intervention. Frequent exposure to sunlight, especially without protection, can lead to the development of rough, scaly patches on the skin. These patches may be accompanied by itching or burning sensations.

Visual aids such as images can aid in identifying actinic keratoses. By familiarizing yourself with these warning signs, you can promptly consult our St. Louis dermatology team for further evaluation.

Diagnosing actinic keratosis typically involves a thorough examination of the affected area by a dermatologist. Biopsies or other tests may be conducted to confirm the diagnosis and rule out any underlying conditions.

Treatment options for actinic keratosis vary depending on the severity of the condition. Topical creams like fluorouracil or imiquimod are commonly used to eliminate precancerous cells.

In some cases, laser therapy, cryotherapy (freezing), or photodynamic therapy may be recommended for more extensive lesions. These procedures aim to destroy abnormal cells while preserving healthy tissue.

The outlook for individuals with actinic keratosis is generally positive if detected early and managed properly. Regular check-ups with a dermatologist are essential for monitoring any changes in existing lesions or identifying new ones.

To prevent actinic keratoses from developing or recurring, it is crucial to practice sun safety measures. This includes wearing protective clothing, applying sunscreen regularly, seeking shade when the sun is strongest, and avoiding tanning beds.

In conclusion, understanding actinic keratosis empowers individuals to take proactive steps in protecting their skin and seeking appropriate medical attention. By being aware of the risk factors, symptoms, and available treatments, you can effectively manage this condition and maintain healthy skin.


Can actinic keratosis turn into skin cancer?

Actinic keratosis can potentially progress into a type of skin cancer known as squamous cell carcinoma. It is important to monitor any changes in existing lesions or the appearance of new ones and consult a healthcare professional for evaluation.

Are there any natural remedies for treating actinic keratosis?

While some natural remedies such as nicotinamide supplements can prevent the development of actinic keratoses, it is crucial to consult with a dermatologist before trying any alternative treatments. Medical interventions are generally more effective in managing this condition.

Can I remove actinic keratoses at home?

Attempting to remove actinic keratoses at home without proper medical guidance can lead to complications or incomplete removal. It is recommended to seek professional treatment from a dermatologist for safe and effective removal.

How long does it take for treatment options like fluorouracil cream or imiquimod cream to work?

The duration of treatment with topical creams such as fluorouracil or imiquimod varies depending on the severity of the actinic keratoses. It may take several weeks or even a few months for noticeable improvement. Consistency in application is key.

Is it possible for actinic keratoses to reappear after successful treatment?

Yes, actinic keratoses can recur after successful treatment. Regular follow-ups with a dermatologist are essential for monitoring any changes and promptly addressing recurrent lesions if they occur.

A dermatologist using a dermatoscope to evaluate an actinic keratosis on a patient's arm.
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