Precancerous Skin Lesions

Skin is the body’s primary defense against bacteria, infections, and environmental stressors. Active monitoring of the skin for signs of precancerous skin lesions and skin cancer is critical to protecting and preserving your skin and your life. When identified and treated during the preliminary stages of skin cancer, treatment is typically highly effective. At Gainesville Dermatology & Skin Surgery, our dermatology team offers comprehensive skin cancer screening and treatment for any type of precancerous skin condition and a wide range of additional skin conditions treated.

Ensure your skin is healthy and protected with the help of our dermatologists — contact our office today to schedule a dermatology appointment.

Common Precancerous Skin Conditions

Each of the following types of precancerous skin conditions may indicate melanoma or squamous cell carcinoma. While actinic keratosis, Bowen’s disease, lentigo maligna, and photodamage may present with different appearances and associated symptoms, each of these conditions poses a critical risk to skin health. As such, it is crucial for patients to understand the causes and signs of each condition as well as promptly contact their dermatologist should any changes to their skin occur. We offer specialized in Mohs micrographic surgery to help our patients achieve healthy, cancer-free skin — contact us to learn more.

Actinic Keratosis (AK)

Actinic keratosis (AK), or solar keratosis, is a rough, scaly patch that develops on the skin following years of exposure to the sun. Patches are commonly found on the face, lips, ears, backs of hands, forearms, scalp, and neck, but they may appear on any part of the body where skin receives sun exposure over time. A common sun-induced lesion, actinic keratosis is the most common precancerous lesion. Advancing age, male sex, and outdoor occupations or hobbies are all risk factors for this condition. Although the risk of AK transforming into squamous cell carcinoma is low, the risk may increase over with an increased number of lesions.

Actinic Keratosis Symptoms

Symptoms of AK include the following. If you discover any of these signs while examining your skin, contact Gainesville Dermatology & Skin Surgery right away to schedule a consultation. 

• A small patch of dry, rough and/or scaly skin, usually less than an inch in diameter
• A patch that is flat or slightly raised on the epidermis
• A patch that varies in color between brownish-pink to red and may burn or itch

Actinic Keratosis Treatment

Individuals with one or more AKs are considered to have sustained a significant degree of sun damage that puts them at high risk for developing skin cancer. Identifying and treating these precancerous lesions help to reduce that risk. Treatment options typically depend on the number of lesions identified, the location of the lesions, the patient’s health, and the patient’s overall health. Possible treatment options include surgical procedures, topical treatments, photodynamic therapy, and combination therapy. The majority of AK lesions are treated and removed as a precaution to avoid the possibility they will develop into skin cancer.

Bowen's Disease

Bowen’s disease is skin cancer in it’s earliest forms. It is characterized by a red, scaly patch on the skin’s surface. The disease affects the squamous cells located within the epidermis, and it is sometimes referred to as squamous cell carcinoma in situ. This precancerous skin condition is typically very slow growing — typically developing after months or years — but it might develop into a more serious type of skin cancer if left untreated, at which point it can spread deeper within the body. Approximately 1 in 20 to 1 in 30 people with Bowen’s disease experience worsening of their condition when left undiagnosed and untreated. 

Bowen's Disease Symptoms

Bowen’s disease usually affects individuals 60–70 years of age. While the exact cause is unclear, it has been closely linked with prolonged sun exposure and a weakened immune system.  It usually appears as one or more patches on the skin with clear edges that do not heal independently. The patch can appear anywhere on the skin, but it commonly develops on the lower legs, neck, and head, among other areas of the body regularly exposed to the sun’s ultraviolet (UV) rays. The following are characteristic of Bowen’s disease patches.

• Red or pink
• Scaly or crusty
• Flat or raised
• 0.5–2 cms wide
• periodically itchy

Bowen's Disease Treatment

If a patch bleeds, develops into an ulcer (open sore), or develops into a lump, it may be a sign that the disease has worsened to squamous cell skin cancer. The primary forms of treatment for Bowen’s disease include cryotherapy, chemotherapy cream, curettage, photodynamic therapy (PDT), and skin surgery. If the patch is growing very slowly, your dermatologist might recommend monitoring the skin closely to ensure treatment is needed at that time. Should treatment be advised, yoour dermatologist will determine whether or not a follow-up therapy is required in order to continue the treatment plan.

Lentigo Maligna

Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are types of melanoma, or skin cancer, that begin when melanocytes — pigments that determine skin color — grow rapidly and subsequently form tumors. LM refers to the early stage of the disease, in which the cancer is confined to the top layer of skin. LMM refers to the disease after it has grown deeper into the skin and is then considered invasive. This variety of melanoma starts as a flat, brown to tan patch on the skin with irregular borders and varied color such that it may darken unevenly over time. As such, gradual darkening and overall appearance of the patch may go unnoticed.

Lentigo Maligna Symptoms

These precancerous lesions are more prevalent in elderly populations who have been significant levels of cumulative sun exposure throughout their lifetime. Commonly affected body regions include the face, neck, forearms, and many additional body parts regularly exposed to the sun. This lesion may be confused with benign skin moles, atypical moles, solar lentigines, or seborrheic keratoses — your dermatologist is specially trained to distinguish these skin lesions and may elect to biopsy any skin findings found suspect.

Characteristics of lentigo maligna include the following.

• Large size (at least 6 mm in diameter)
• Irregular share
• Varied pigmentation
• Brown, tan, pink, red, or white
• Smooth surface

Characteristics of lentigo maligna that has developed into lentigo maligna melanoma include the following.

• Thickening of part of the lesion
• Increasing number of colors
• Blue or black-colored lesions
• Ulceration or bleeding
• Itching or stinging

Lentigo Maligna Treatment

The usual treatment for a lentigo maligna is local excision of the affected skin with a 5 mm margin of normal tissue. Larger margins or Mohs surgery may be used if the edges of the lesion are unclear. If the lesion is located in an area that makes it difficult to excise, other treatments, such as radiation, cryosurgery, or imiquimod cream may be considered. If a biopsy indicates a diagnosis of lentigo maligna melanoma, the condition is treated in a protocol similar to that of malignant melanoma, in which the aggressiveness of treatment depends on the thickness of the lesion as well as the pathology report.

Photodamage

Photodamage is defined as changes in the skin that occur after prolonged exposure to solar irradiation. Photoaging, or premature aging skin, is one of the results seen with photodamage, which is an alteration of the skin resulting from sun exposure and resembling the effects of natural aging. UV radiation affects the skin’s collagen fibers — damage to collagen results in a loss of skin elasticity, which results in the early development of wrinkles as well as other age markers. Photodamage can cause skin discoloration (color photodamage), the loss of collagen (dermal photodamage), and the development of cancerous lesions (epidermal photodamage).

Photodamage Symptoms

Photodamage looks different for every individual. The signs of photodamage are most likely to appear on the face and neck, but they may occur anywhere the skin experiences significant and chronic sun exposure, such as the chest, back, upper arms, and legs. Epidermal photodamage might be apparent. If you have color photodamage and dermal photodamage symptoms, it’s important to have our dermatologist evaluate whether you have also sustained epidermal photodamage. Most individuals with photodamage experience the following.

Photodamage Treatment

While the best treatment for photodamage is prevention by avoiding exposure of your skin to the sun’s UV rays, depending on the severity of the condition, certain sun-damage treatments may be effective in reducing the appearance of photodamage. Over-the-counter and prescription chemical exfoliants and antioxidants can help reduce the appearance of sun damage. For patients who have more severe and extensive photodamage, our dermatologists will recommend the best course of treatment for their specific health and cosmetic needs.

How To Avoid Sun Exposure

While not all forms of precancerous skin lesions and types of skin cancer are preventable, the vast majority of these lesions are. Ensuring adequate sun protection is integral to preserving your health and your appearance. Consider the following tips for avoiding sun exposure.

• Wear sun-protective clothing. Clothing featuring an Ultraviolet Protection Factor (UPF) rating is designed to help prevent UV rays (both UVA and UVB)  from penetrating your clothing and reaching your skin. Pick long sleeves, pants, and wide-brimmed hats.
• Apply broad-spectrum sunscreen. Apply at least one ounce of a broad-spectrum sunscreen with a Sun Protection Factor (SPF) of at least 35 daily to ensure exposed skin is protected from the sun’s harmful UV rays.
• Reapply sunscreen regularly. Sunscreen requires reapplication every couple hours to be effective throughout the day — if you are swimming or sweating while outdoors, reapply sunscreen every hour to ensure proper coverage.
• Limit sun exposure during the day. Limit the amount of time you’re in the sun from 10 am. to 4 p.m. This is when the sun’s rays are most intense and, thus, most harmful to the skin. If you must be outside, seek shade!
• Practice the shadow rule. While outdoors, we recommend practicing the shadow rule to ensure you avoid the sun at its peak strength. If while outside, you notice your shadow is shorter than you, the sun’s rays are at their strongest and you should find shade.
• Check your medications. Those taking medications, such as specific types of antibiotics, anti-inflammatories, antifungals, blood pressure medications, and chemotherapy, that increase sun sensitivity should be extra cautious while outdoors.