Actinic keratoses
Actinic keratoses are a preliminary stage or very early form of squamous cell carcinoma, which is a type of non-melanoma skin cancer. Beauticians can recognize the first signs and provide advice, but the suspicion should always be clarified by a dermatologist.
How do actinic keratoses develop?
Actinic keratoses develop as a result of chronic photodamage to the skin caused by ultraviolet (UV) radiation. This is why they are sometimes also called solar keratoses. In addition, this skin change is accompanied by a cornification disorder of the uppermost skin layer, which causes the characteristic appearance of actinic keratoses.
Actinic keratoses typically appear as reddish or skin-colored, brown or yellowish spots on the skin. When stroked over, they feel rough and scaly (“like sandpaper”). They usually occur on skin areas that are chronically exposed to the sun. These parts of the body are referred to as sun terraces, including hands, forearms, head and face, décolleté and other light-exposed areas. Often, several actinic keratoses occur in one skin area, e.g. on the scalp.
Which people are more likely to develop actinic keratoses?
People with fair skin, people with increased UV exposure (e.g. due to an outdoor occupation), people with a disturbed immune system, e.g. due to taking certain medications, and people over 50 years of age are particularly affected.
Actinic keratoses are considered to be a precursor to skin cancer. They represent a precursor or very early form of squamous cell carcinoma (also called spinalioma, squamous cell carcinoma) and should therefore be treated by a doctor as early as possible.
Depending on the number of tumors, their size and thickness, their location and the patient’s wishes, this may include surgical removal, cold therapy with liquid nitrogen (cryotherapy), laser therapy and photodynamic therapy (PDT).
Squamous cell carcinoma
Squamous cell carcinoma, the second most common malignant skin tumor, usually begins with a thickening of the stratum corneum of the epidermis and then grows into the surrounding tissue, with the edges often inflamed. At the center of the squamous cell carcinoma, there is usually an ulcer with a grater-like palpation.
It often occurs at the transition between skin and mucous membrane, e.g. on the lips. It can also develop on scar tissue. The chances of recovery from squamous cell carcinoma are generally good if it is detected and treated early.
The standard medical treatment for squamous cell carcinoma is complete surgical removal. In special cases, radiotherapy is also indicated. If not all of the tumor tissue could be removed during the operation or if more than three lymph nodes are affected, supportive radiotherapy is recommended after the operation (so-called adjuvant radiotherapy).
Early skin cancer detection
Skin cancer screening or skin cancer early detection examinations, in which the entire body is thoroughly examined for conspicuous skin changes, are used in particular to detect the preliminary and early stages of skin cancer.
In Germany, anyone with statutory health insurance who is over 35 years of age is entitled to a free skin cancer screening every two years. This can be carried out by a dermatologist. However, other doctors who are qualified to perform this early detection examination (e.g. general practitioners and internists) now also offer this examination.
Some health insurance companies already offer skin cancer screening for those under 35 years of age, so it is worth asking your own health insurance company to take advantage of this offer. Unfortunately, the offer of early skin cancer detection is currently still underused.
Everyone in Germany with statutory health insurance who is over 35 years old is entitled to a free skin cancer screening every two years.
Prevention is the be-all and end-all
Check the UV index in the weather app
The UV index can be used as a guide to help you assess the need for sun protection. This can be accessed free of charge and updated daily, for example, on the website of the German Weather Service or via certain smartphone apps.
From a UV index of three, sun protection is strongly recommended. In general, in Germany, the intense midday sun between 11 a.m. and 4 p.m. should be avoided from April to September. In addition, shading measures (e.g. sun sails) are generally recommended. This reduces exposure to solar UV radiation.
Personal sun protection measures primarily include the use of textile sun protection (ideally long-sleeved shirts, long trousers and gloves, clothing with a UV protection factor if necessary, and protective headgear with brim, neck and ear protection, as well as closed shoes). It also makes sense to protect your eyes with suitable UV-filtering sunglasses. This protection is complemented by the use of sunscreen products.
Sunscreen products and the like
The cosmetics industry today offers a wide range of different sunscreen products, ranging from creams, gels and lotions to sprays. Generally, when choosing a suitable sunscreen, attention should be paid to the skin type: For example, a sunscreen with a higher fat content (e.g. sun cream) can be used for skin that tends to be dry, while oily skin benefits from lighter textures (e.g. sun gel or lotion).
Whenever a part of the body cannot be protected by a textile sunscreen, such as the face, a sunscreen should be used. This should be equipped with a broadband filter, i.e. filter both UVA and UVB rays, and have a sun protection factor (SPF) of at least 30, preferably 50+.
To achieve the advertised sun protection factor, a sufficient amount (2 mg/cm²) of the sunscreen must be applied – for the head, face and neck, this is two strips of sunscreen from the tip to the base of the index and middle fingers. Applying too little reduces the protection drastically. Regular reapplication is recommended, about every two hours, and more often if you sweat a lot. After spending time in the water, the sunscreen should be completely reapplied. Don’t forget your lips either; there are now special lip balms with integrated sun protection for them.
Occupations in the “fresh” air
The S3 guideline “Prevention of Skin Cancer” of the Association of the Scientific Medical Societies in Germany (AWMF) names, among others, people who spend a lot of time in the sun as a risk group for developing skin cancer. The occupational group of people who work outdoors is mentioned as an example.
These include, among others, employees in the construction and skilled trades, agriculture and forestry, fishing and seafaring, and horticulture. The data showing that outdoor workers are at double the risk of non-melanoma skin cancer compared to the average population has led to UV-induced skin cancer being recognized as an occupational disease in various European countries.
Squamous cell carcinomas, including their early forms, actinic keratoses, can be recognized under occupational disease (BK) No. 5103.
Our tips for sun protection
– Choose a sunscreen that matches your skin type.
– Always apply sunscreen when a part of your body cannot be protected by clothing.
– The sunscreen should have a broad-spectrum filter, i.e. it should filter both UVA and UVB rays.
The sun protection factor (SPF) should be at least 30, preferably 50+.
To achieve the stated sun protection factor, a sufficient amount (2 mg/cm²) of the sunscreen must be applied. For the head, face and
neck, this is two strips of sunscreen from the tip to the base of the index and middle fingers.
Reapply regularly (about every two hours).
Reapply sunscreen after being in the water.
Don’t forget your lips either: there are now special lip care sticks with integrated sun protection for them.
Actinic keratoses – can be avoided
Exposure to the sun’s rays will definitely damage the skin if adequate sun protection is not worn. Yes, sun protection products are greasy and expensive, but prevention is extremely important because the precursors of actinic keratoses are difficult to recognize. Cosmacon has already developed several sun protection products with SPF 100 and more that can be used for actinic keratoses. Please feel free to ask us for advice so that you too can offer a high-quality sun protection product under your brand.
Literature:
https://www.beauty-forum.com/medical/dermatologie/wenn-licht-schadet
Medical 02/2024; Dr. Cara Symanzik
Marques E, Chen TM.2023 Aug 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–
Genetic Studies of Actinic Keratosis Development: Where Are We Now?
Lee YB, Kim JI.Ann Dermatol. 2023 Dec;35(6):389-399.
Chemical Peels for Skin Resurfacing.
Samargandy S, Raggio BS.2023 Oct 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–