The number of people in SA with AKs is also likely to be high due to our high numbers of immunocompromised people, people with albinism and high rates of alcohol consumption. All three predispose patients to developing AK. South Africa also experiences high levels of UV light, particularly during spring and summer.
AK is caused by frequent sun exposure or tanning bed use. Both these expose the skin to very high levels of UV light, which can damage the DNA in our skin cells, leading to runaway mutations in the cell. In AK, these mutations present on the skin of the face, neck, hands or scalp. Actinic keratoses usually present as rough, wart-like and unattractive patches.
WHY TREAT AKs
AKs are unappealing and can have a seriously negative effect on a patient’s self-esteem and general quality of life. But the most compelling reason to treat AKs is that they could develop into SCC or BCC. If AKs start bleeding or itching, don’t respond to treatment, change their shape or colour or become thicker, they are possibly transforming into SCC or BCC and urgent intervention is required.
It’s impossible to predict which AK lesions will develop into SCC or BCC, so it’s best to be proactive and get all lesions treated before complications arise.
It is best for AKs to be treated in primary care before progression to skin cancer occurs. Some therapies aim at removing individual lesions, but this approach has been discredited since it is very hard to tell whether some lesions have a subclinical component (under the skin). It is entirely possible to remove the upper part of a lesion but leave a large part of the lesion untouched and unseen beneath the upper skin layer.
This subclinical lesion is likely to cause a recurrence of the visible lesion at some point. For this reason, field therapy is the best option for AK treatment. In field therapy, the surface and subclinical lesions are targeted. The most common forms of field therapy are topical creams like imiquimod.
Field therapy has been compared to other treatments for AK multiple times. When compared to curettage, cryotherapy or even forms of chemotherapy like 5-fluouracil, field therapies like imiquimod have been proven to treat the entire field and get rid of subclinical lesions, while also minimising scarring and other negative outcomes.