Does acnitic keratosis always turn into squamous cell carcinoma or can it also turn into basal cell carcinoma?

Prior to 3 areas developing on my chin that will not go away, for several years I had an area on my chin that was wart-like, it was small and skin colored and from the research I have done it is called acnitic keratosis(pre-cancer). It would come and go. But now I have the sores on my chin that won't go away for 2 months now. I do have an appointment at the end of this month with the dermatologist and I am on the cancellation list. Unfortunately I am one that loves the sun, I just returned from an Island and prior to going I did use the tanning bed like I do every year. I also have a Hx of CA in my family , my mother had breast CA and alot of my aunts and uncles on my mothers side has had some type of CA. I know with my Hx of CA and sun exposure you are probably saying how stupid could you be?? You just never think it will happen to you until it does. Maybe I'm overdiagnosing but I have to wait a month to find out.

Does acnitic keratosis always turn into squamous cell carcinoma or can it also turn into basal cell carcinoma?
An actinic keratosis is sometimes a precurser to squamous cell carcinoma. Basal cell carcinomas are also caused by excess UVA damage but in a different type skin cell. The ratio of AKs that convert into SCC varies but is around 2-15%. My own estimate is about one in six if the AK is given enough time to keep growing. Here is a new article from PUBMED discussing this same question.





Eur J Dermatol. 2006 Sep;16(4):335-9. Links


Actinic keratosis: how to differentiate the good from the bad ones?Quaedvlieg PJ, Tirsi E, Thissen MR, Krekels GA.


Department of Dermatology, University Hospital Maastricht, P.Debyelaan 25, Postbox 5800 6202 AZ Maastricht, The Netherlands. pqua@home.nl





Our objective was to obtain practical clinical parameters to indicate those actinic keratoses (AK) that are at risk of becoming invasive. A systematic review of the literature, with focus on randomized trials, retrospective studies and reviews was undertaken. The main outcome measure was the rates and clinical features of AK that transformed into SCC. This study reviewed randomized and retrospective studies and reviews of AK and their risk of becoming SCC. We reviewed a total of 875 studies and identified 62 useful prospective, retrospective studies and reviews. Finally 15 studies covering percentage and/or clinical parameters of malignant transformation were found to be useful: a total of 9 reviews, 4 randomized controlled trials and 2 retrospective studies. Only 1 study (meta-analysis) examined the percentage of malignant transformation and found a rate between 0.025% and 20% per year/per lesion. Clinical parameters found were: induration (3 studies), bleeding (3 studies), enlargement in diameter (3 studies), erythema (2 studies) and ulceration (2 studies). Other minor clinical criteria were pain, palpability, hyperkeratoses, pruritic lesions and pigmentation. The amount of quality research on the most common premalignant lesion in humans is disappointing. The only longitudinal study looking at the incidence of malignant transformation of AK to SCC dates from 1988.Besides the known risk factors (skin type, photodamage, immunosuppression etc), based on this review we found clinical features that provide a practical guide to practitioners in the treatment of AK. Although not prospectively studied, clinical parameters indicating those AK with an increased risk of malignancy are IDRBEU. I (Induration /Inflammation), D (Diameter %26gt; 1 cm), R (Rapid Enlargement), B (Bleeding), E (Erythema) and U (Ulceration). In future prospective studies, these parameters should be included.


PMID: 16935787 [PubMed - indexed for MEDLINE]





Your family history of breast cancer does not influence your own chances of developing skin cancer but your history of tanning and sun exposure certainly does. You can reverse the development of many AKs with the prescription medicine Solaraze (topical diclofenac) if you apply it twice daily for three months or so. AKs that do not respond to Solaraze either need cryosurgery (freezing) or surgical removal. Solaraze will not effectively treat a SCC so if the Dr suspects you have a SCC it is better to treat the suspected SCC first with biopsy and excision and then treat any remaining non threatening AKs with Solaraze. Solaraze will not help if you continue tanning or sun exposure.





http://www.bradpharm.com/products/Doak/p...





If you do end up being diagnosed with SCC then you need to realize that your tanning and heavy sun exposure days are over because once you have one SCC of the skin the chances of you developing a second SCC are increased and will not decrease. Chances are about 40-70% that a person with one biopsy proven SCC will develop another one within five years.





http://www.aad.org/public/Publications/p...





There is some preliminary research that indicates drinking green tea daily might reduce a person's chances of developing skin cancers due to excess sun exposure and possibly help in the DNA repair of UVA damage of the skin. So far the research is not completely convincing but if you like drinking tea it certainly won't hurt any to add tea to your daily diet.





Skin cancer chemoprevention: strategies to save our skin.Einspahr JG, Bowden GT, Alberts DS.


Arizona Cancer Center, University of Arizona, P.O. Box 245024, Tucson, AZ 85724, USA.





There are over 1 million cases of skin cancer diagnosed yearly in the United States. The majority of these are nonmelanoma (NMSCs) and are associated with chronic exposure to ultraviolet light (UV). Actinic keratosis (AK) has been identified as a precursor for SCC, but not for BCC. AKs are far more common than SCC, making them excellent targets for chemoprevention. Cancer chemoprevention can prevent or delay the occurrence of cancer in high-risk populations using dietary or chemical interventions. We have developed strategies that have rational mechanisms of action and demonstrate activity in preclinical models of skin cancer. Promising agents proceed to phase I-III trials in subjects at high risk of skin cancer. UV light induces molecular signaling pathways and results in specific genetic alterations (i.e., mutation of p53) that are likely critical to skin cancer development. UVB-induced changes serve as a basis for the development of novel agents. Targets include inhibition of polyamine or prostaglandin synthesis, specific retinoid receptors, and components of the Ras and MAP kinase signaling pathways. Agents under study include: epigallocatechin gallate (EGCG), a green tea catechin with antioxidant and sunscreen activity, as well as UVB signal transduction blocking activity; perillyl alcohol, a monoterpene derived from citrus peel that inhibits Ras farnesylation; difluoromethylornithine (DFMO), an inhibitor of ornithine decarboxylase and polyamines; retinoids that target retinoid X receptors and AP-1 activity; and nonsteroidal anti-inflammatory agents that inhibit cylooxygenase and prostaglandin synthesis. We performed a series of Phase I-II trials in subjects with multiple AK. For example, a phase II randomized trial of topical DFMO reduced AK number, suppressed polyamines, and reduced p53 protein. Our goal is to develop agents for use in combination and/or incorporation into sunscreens to improve chemoprevention efficacy and reduce skin cancer incidence.


PMID: 12903851 [PubMed - indexed for MEDLINE]
Reply:No, it doesn't always turn into cancer:


"It is estimated that 10 to 15 percent of active lesions, which are redder and more tender than the rest will take the next step and progress to squamous cell carcinomas."





Of course, you may be one of those that it does become cancerous---since you refuse to stay away from the UV rays that are the EXACT cause of your skin problems. I would find another dermatologist immediately. Don't wait a month.





http://www.aocd.org/skin/dermatologic_di...
Reply:I have acnitic keratosis. I just went to the dermatologist. I am VERY pale skinned. I burn walking from work to the car. I have some on my hands, chest and nose. She said 96% or so will not turn into cancer. You should start wearing sunblock and stop being a sun lover. Get a fake tan. That's what I've always had to do. It's not so bad. Who cares if you look like an albino. It's your life and skin. Protect it or die of cancer. With all that history of cancer in your family it looks like you would think twice before lying there and baking in the sun. You are at a very high risk.
Reply:Do you mean "Actinic keratosis"?


Actinic keratosis (also called solar keratosis, senile keratosis, or AK) is a premalignant condition of thick, scaly, or crusty patches of skin. It is most common in fair-skinned people who are frequently exposed to the sun, because their pigment isn't very protective. It usually is accompanied by solar damage. Since some of these pre-cancers progress to squamous cell carcinoma, they should be treated.


Please see the web pages for more details on Actinic keratosis.

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