Diagnosis | Actinic keratosis


Mostly the diagnosis is made clinically, i.e. on the basis of the symptoms and the visible and palpable findings on the skin. To confirm the diagnosis, a skin sample (biopsy) should be taken and pathological and histological examinations should be performed. A skin sample can also be used with an incident light microscope to differentiate it from other skin diseases such as seborrhoeic keratoses.

Therapy of actinic keratosis

The actinic keratosis is a preliminary stage or early form of the light skin cancer and must therefore be taken very seriously as such. Therefore an early therapy is very important. There are different approaches available for the treatment of actinic keratosis.

An experienced dermatologist can inform about the different therapy options. In the following section, the most important therapy options are clearly presented and their implementation is explained in more detail:

  • Lesion-oriented therapy with liquid nitrogen/cryosurgery: Small skin lesions can be frozen with liquid nitrogen under local anaesthetic. This procedure is also known as cryosurgery.
  • Surgical removal: Actinic keratoses can also be surgically removed under local anaesthetic. The removed material is then examined in more detail to identify and classify precancerous lesions or a cancerous disease. – Removal using laser therapy: With the help of a laser, the uppermost layers of the skin affected by changes can be destroyed.

Underlying tissue is spared in this way. – Curettage: Curettage is a treatment in which the altered skin material is scraped off with a so-called “sharp spoon” (curette). This treatment is also performed under local anaesthetic.

The material obtained is further examined after the treatment. – Field therapy with flat acting substances: If large areas of the skin are affected by actinic keratosis, this is called field carcinogenesis. In this case, it is not possible to remove all the altered skin areas.

Therefore, ointments, creams or gels with substances which act flat are applied. These include cytostatic agents, immunosuppressive and anti-inflammatory substances which are applied over several weeks. Frequently used substances are imiquimod, 5-fluoruracil or diclofenac.

  • Photodynamic therapy: Photodynamic therapy is also a procedure that achieves good results in the case of extensive skin infestation. It leaves no scars and therefore leads to cosmetically satisfactory results. First an ointment is applied which contains a dye-like substance.

Then the skin is irradiated with a cold red light. The treatment can be repeated after a few months. In case of punctual changes of the skin, it is possible to freeze the affected areas with liquid nitrogen.

This procedure is also known as cryosurgery. The cold destroys the altered skin cells and is therefore suitable for the treatment of the precancerous stage. A distinction is made between two procedures, namely the spray procedure and the contact procedure.

In the open spray procedure, liquid nitrogen is sprayed onto the changed skin. In this way tissue up to a depth of 12 mm can be destroyed. However, it is also possible to place a probe or a pre-cooled metal stamp directly on the actinic keratoses.

This is known as a contact procedure. The treatment can usually be performed under local anaesthesia on an outpatient basis and is gentle on the patient. In the treatment of actinic keratosis, a distinction is made between “lesion-oriented therapy” and “field therapy”.

The “field therapy” is used when large areas of the skin are affected by the changes. Another reason is the co-treatment of skin areas where changes in the cells already exist but are not yet visible. One possibility for a “field therapy” is the treatment with an ointment, cream or gel.

Such ointments contain anti-inflammatory substances, antivirals or cytostatic agents. Cytostatic drugs kill cancer cells, or their precursors, and are therefore very well suited for therapy. Antivirals are agents that combat viruses.

Some substances, such as imiquimod, achieve very good results in the treatment of actinic keratosis and are therefore used very frequently. Other important active substances are 5-fluoruracil and diclofenac. These substances are applied to the skin over several weeks following a treatment regimen and do not leave scars.

Apart from the cosmetic result, a great advantage for the patients is that even areas of the skin that do not yet show any visible changes are treated. The risk of a relapse is reduced in this way. As actinic keratosis is a disease requiring urgent treatment, the costs for a therapy are covered by the health insurance companies.

This applies at least to classic forms of treatment, such as icing, surgical removal or therapy with locally acting substances. Unfortunately, not every health insurance company covers the costs of photodynamic therapy. Whether a photodynamic therapy is covered by the health insurance company depends on the individual insurance company’s services and the respective case.

Therefore, it is recommended to talk to the health insurance company before carrying out such a treatment. At this point, homeopathic treatment of actinic keratosis can only be strictly discouraged. Actinic keratosis is an early form of white skin cancer which may progress if not treated. The consequences of advanced cancer are potentially fatal. Homeopathic treatments are therefore not recommended.