Skin Cancer: Can You Repair The Damage Done?

Actinic keratosis
This magnification of the skin's epidermis reveals an actinic keratosis, which is caused by exposure to the sun. Nephron, Creative Commons

It's natural to be concerned about the signs of aging on your skin, especially since many of those signs may be indications of future cancer. In fact, actinic keratoses (AK), though extremely common, are scaly or crusty growths (lesions). These are not simple "age spots" but warnings that your years of exposure to ultraviolet radiation from the sun have caused genetic changes in your keratinocytes, the cells in your outermost layer of skin.

Actinic keratoses most often appear on the backs of hands and forearms, a bald scalp, face, ears, lips, shoulders, neck or any other areas of the body frequently exposed to the sun.

If actinic keratoses have begun to appear on your skin, then you have sustained damage. Although most individual lesions do not become invasive cancers, the majority of invasive squamous cell carcinomas (a type of treatable skin cancer) originate from actinic keratoses. Genetic analysis demonstrates that ultraviolet radiation-induced mutations and changes in gene expression are present in squamous cell carcinoma, actinic keratoses, and normal-appearing sun-exposed skin.

The nature of these changes to your skin, then, are clearly progressive so actinic keratoses need to be stopped before they completely transform into cancer.

One of the Latest Treatments

While the risk of progression within a year of a single AK lesion to squamous cell carcinoma is low, most patients with sun-damaged skin have many lesions. This raises the risk of invasive squamous cell carcinoma to 10 percent over 10 years. Although these numbers do not indicate a large or imminent threat, those of a mind to prevent cancer and its spread should have enough time to consider treatment options with their doctor and undergo a regimen if they so choose.

When treating actinic keratoses, doctors focus on two methods: individual lesion and field-directed. Field-directed means treating the entire "cancer field," both the visible and subclinical lesions present in photodamaged skin. Frequently, multiple methods of treatment, including surgical procedures, creams, photodynamic therapy, radiation, and biotherapy, are selected based on the characteristics of the lesions and overall sun damage. Often, lesions are surgically removed (in many cases, this is a simple in-office procedure) with follow-up care in the form of a medicated cream.

In many instances of treatment, creams and solutions are effective, but the regimen can be lengthy and intolerable to patients because of inflammatory reactions. Recently approved by the Food and Drug Administration, ingenol mebutate gel is a topical treatment that induces cell death of the genetically damaged keratinocytes while it promotes an inflammatory response; the mechanism is not fully understood and continues to be studied. A recent study finds ingenol mebutate to be highly effective in clearing AK on the trunk of the body or extremities and face or scalp after once-daily application for two or three consecutive daily treatments. Significantly, the inflammatory skin responses experienced by the participants in the study were generally mild to moderate and resolved in approximately two to four weeks. The actual clearance rate after an ingenol mebutate treatment regimen also compares well with those achieved with other field therapies that require longer treatment periods, such as a four-week treatment regimen of 5-fluorouracil.

Overall, researchers believe ingenol mebutate's short treatment time and mild-to-moderate skin reactions should facilitate treatment adherence in patients who have difficulty with longer therapy courses. In other words, if you have actinic keratoses that need to be treated, this may be both an effective and relatively easy option.

What About Now?

Since sun damage accumulates over time, it's never too late to practice sun safety. To help stop or even reverse damage to your skin, the Centers for Disease Control and Prevention recommends you to follow these simple guidelines:

  • Use sunscreen with an SPF of 15 or higher and both UVA and UVB protection. By reducing your daily sun exposure, sunscreen allows your skin time to heal and possibly gives your immune system the chance to repair existing damage.
  • Hydrate inside and out. Summer exposure to sun, chlorine, and salt water can dry out your skin. In addition to using hand and body creams that stimulate hydration, you should also begin drinking more water.
  • Sunglasses. Wear sunglasses that block as close to 100 percent of both UVA and UVB rays as possible.
  • Clothing. Wear sun-protective clothing and a hat.
  • Shade. Stay in the shade, especially during midday hours, as a way to passively reduce your exposure to the sun.

 

Sources: Martin G, Swanson N. Clinical findings using ingenol mebutate gel to treat actinic keratoses. Journal of the American Academy of Dermatology. 2013.

Berman, B. New developments in the treatment of actinic keratosis: focus on ingenol mebutate gel. Clinical, Cosmetic, and Investigational Dermatology. 2012.

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