Actinic Keratosis (AK)
Also known as solar keratosis, actinic keratosis affects more than 10 million Americans. These precancerous growths on the skin are caused by overexposure to the sun over a long period of time. They are characterized by rough dry lesions or patches that appear on sun-exposed areas of the skin, such as the face, back of hands, arms, scalp or shoulders. The lesions may be red, pink, gray or skin colored. Lesions often begin as flat, scaly areas and develop into a rough-textured surface. Sometimes it is easier to feel a growth than it is to see it.
Actinic keratosis is more common among fair-skinned people and those who have had years of outdoor or tanning bed exposure to ultraviolet light. Actinic keratosis can develop into malignant cells, typically squamous cell carcinoma, which is a type of skin cancer. That's why treatment is important.
After a physical examination and sometimes, a biopsy of the lesion, your dermatologist will opt for one of the following treatments to remove the growth:
- Cryosurgery, which freezes off the growth using liquid nitrogen.
- Surgical removal in which the doctor removes the lesion and bleeding is stopped by electrocautery.
- Chemical peels that cause the top layer of skin to peel off.
- Photodynamic therapy in which a medicine is applied that sensitizes the skin to light and the area is then exposed to "Blu" light.
- Topical Chemotherapeutic agents (5 Fluorouracil, Imiquimod) can also be used with various protocols.
Granuloma is a generic term that refers to a small nodule. It can be any type of nodule, from benign to malignant. Granulomas occur throughout the body. Two types of granuloma apply expressly to the skin:
Pyogenic Granuloma. Pyogenic granuloma looks like a small, reddish bump on the skin that tend to bleed. They are often caused by an injury to the skin and are fairly common in pregnancy. They are most frequently found on the hands, arms and face. In some cases, the nodule will spontaneously disappear. More often, the lesions need to be removed by surgery. There may be some mild scarring as a result of these treatments.
Granuloma Annulare. This type of nodule can occur in any person, but is more common in children and young adults. It is characterized by a ring-shaped lesion that is round and firm; red, white or purple skin around a clear center of normal skin and is not scaly. It can appear individually or in groups. Most often, it appears on tops of hands and feet, elbows and knees. Most people have no other symptoms, but some may experience itchiness at the site of the lesion. Granuloma annulare can resolve itself and may or may not disappear over time without treatment. However, if the incidence is widespread or aesthetically undesirable, a dermatologist may prescribe a steroid cream or inject steroids just below the skin’s surface to speed healing.
Moles are tan, brown or black growths, usually round or oval, that can appear anywhere on the skin. They can be rough or smooth, flat or raised, single or in multiples. They occur when cells that are responsible for skin pigmentation, known as melanocytes, grow in clusters instead of being spread out across the skin. Generally, moles are less than one-quarter inch in size. Most moles appear by the age of 20, although some moles may appear later in life. Most adults have between 10 and 40 moles. Moles may disappear by themselves over time.
Most moles are harmless, but a change in size, shape, color or texture or bleeding could be indicative of a cancerous growth. Moles that have a higher-than-average chance of becoming cancerous include:
Giant Congenital Nevi
Moles present at birth. The larger their size, the greater the risk for developing into a skin cancer.
Atypical Dysplastic Nevi
Irregularly shaped moles that are larger than average. They often appear to have dark brown centers with light, uneven borders. The trait sometimes runs in families.
Higher frequency of moles
People with 50 or more moles are at a somewhat greater risk for developing a skin cancer.
In some cases, abnormal moles may become painful, itchy, scaly or bleed. It's important to keep an eye on your moles so that you can catch any changes early. We recommend doing a visual check of your body monthly, including all areas that don't have sun exposure (such as the scalp, armpits or bottoms of feet).
Use the American Academy of Dermatology's ABCDEs as a guide for assessing whether or not a mole may be becoming cancerous:
Asymmetry: Half the mole does not match the other half in size, shape or color.
Border: The edges of moles are irregular, scalloped, or poorly defined.
Color: The mole is not the same color throughout.
Diameter: The mole is usually greater than 6 millimeters when diagnosed, but may also be smaller.
Evolving: A mole or skin lesion that is different from the rest, or changes in size, shape, or color.
If any of these conditions occur, please make an appointment to see a dermatologist right away. The doctor may do a biopsy of the mole to determine if it is or isn't cancerous and/or may surgically remove it.
Seborrheic Keratosis (SK)
Most people will develop at least one seborrheic keratosis during a lifetime. Fortunately, these lesions are benign and don’t become cancerous. They are characterized as brown, black or yellow growths that grow singly or in groups and are flat or slightly elevated. Often they are mistaken for warts. Generally, no treatment is required unless the growth becomes irritated from chafing against clothing.
If a seborrheic keratosis becomes irritated or unsightly, removal is conducted using one of these methods:
- Cryosurgery, which freezes off the growth using liquid nitrogen.
- Curettage, in which the doctor scrapes the growth off the surface of the skin.
- Electrocautery, used alone or in conjunction with curettage to burn off the tissue and stop the bleeding.
Warts are small, harmless growths that appear most frequently on the hands and feet. Sometimes they look flat and smooth, other times they have a dome-shaped or cauliflower-like appearance. Warts can be surrounded by skin that is either lighter or darker. Warts are caused by different forms of Human Papilloma Virus (HPV). They occur in people of all ages and can spread from person-to-person and from one part of the body to another. Most warts are benign (noncancerous) and generally painless. They may disappear without any treatment. However, in most cases eliminating warts takes time. Certain genital warts are precancerous. The type is determined through a biopsy.
The location of a wart often characterizes its type:
Common warts can appear anywhere on the body, although they most often appear on the back of fingers, toes and knees. These skin-colored, dome-shaped lesions usually grow where the skin has been broken, such as a scratch or bug bite. They can range in size from a pinhead to 10mm and may appear singly or in multiples.
Filiform warts look like a long, narrow, flesh-colored stalk that appears singly or in multiples around the eyelids, face, neck or lips.
Flat (plane) warts appear most commonly on the face and legs. They are flesh-colored or white, with a slightly raised, flat surface and they usually appear in multiples. Flat warts are more common among children and teens than adults.
Genital warts appear around the genital and pubic areas. It is also possible to get genital warts inside the vagina and anal canal or in the mouth (known as oral warts). The lesions start small and soft but can become quite large. They often grow in clusters. They are both sexually transmitted and highly contagious. In fact, it is recommended you generally avoid sex with anyone who has a visible genital wart. Genital warts should always be treated by a physician, as there are precancerous types.
Plantar warts appear on the soles of the feet and can be painful since they are on weight-bearing surfaces. They have a rough, cauliflower-like appearance and may have a small black speck in them. They often appear in multiples and may combine into a larger wart called a mosaic wart. Plantar warts can spread rapidly.
Subungual and periungual warts appear as rough growths around the fingernails and/or toenails. They start as nearly undetectable, pin-sized lesions and grow to pea-sized with rough, irregular bumps with uneven borders. Subungual and periungual warts can impede healthy nail growth. Because of their location, they are difficult to treat and generally require medical attention.
Most warts respond to treatments, including:
- Cryotherapy, which freezes off the wart using liquid nitrogen.
- Immunotherapy, which stimulates the immune system to kill the wart virus.
- Electrosurgery, which sends an electric current through the wart to kill the tissue.
- Salicylic acid preparations, which dissolve the protein (keratin) that makes up the wart and the thick layer of skin that covers it. It comes in gels, pads, drops and plasters and takes 4 to 6 weeks to eradicate the warts.
If self-treatments don't work after a period of about 4 to 12 weeks, contact Schaberg Dermatology. We'll assess your warts and recommend the best option. We typically combine liquid nitrogen treatment with topical medications that stimulate the immune system to kill the virus. Always contact the dermatologist if a wart is causing pain, changes in color or appearance and for all genital warts.