The Importance of Regular Skin Examinations: A Case of Actinic Keratosis and Monitoring Non-Melanoma Skin Cancer
By Dr. Tony Nguyen, Village Dermatology
At Village Dermatology’s Katy office, we understand that skin health becomes increasingly important as we age, particularly for those with a history of skin cancer or pre-cancerous lesions. I have seen a 62-year-old patient for her annual full-body skin examination. With a history of basal cell carcinoma and actinic keratoses (AKs), this patient is closely monitored to manage her skin health and address any emerging concerns.
In this post, I’ll discuss the findings of her examination, the treatments provided, and essential recommendations for those with a history of skin lesions or significant sun damage.
Patient Background and History
This patient’s medical history includes:
A previous basal cell carcinoma removed from her forehead four years ago.
A history of actinic keratoses, pre-cancerous lesions commonly associated with cumulative sun damage. Learn more about actinic keratosis and its risks.
During this visit, her skin showed several areas of concern. Actinic keratoses lesions, common on sun-exposed areas, were found on her left central cheek, left inferior forehead, right neck, superior thoracic spine, and left upper back. Given her history and the appearance of these lesions, we treated the AKs immediately using liquid nitrogen.
Actinic Keratosis Treatment and Follow-Up Care
Actinic keratoses are often a precursor to squamous cell carcinoma if left untreated. While the risk of progression is low, regular treatment and monitoring are essential. During this visit, we applied cryotherapy (liquid nitrogen) to five actinic keratosis lesions, a standard treatment that freezes abnormal cells, causing them to slough off.
For patients with extensive actinic damage like this patient, topical treatments such as Efudex (5-fluorouracil) and calcipotriene may be recommended for long-term care. These topical agents help treat existing lesions and prevent new ones from forming. The patient was advised to apply these treatments to her lower legs, arms, hands, chest, and face, which have shown significant sun damage over time. You can read more about our actinic keratosis treatment options here.
Expected Outcomes and Precautions
Patients undergoing treatment for AKs should monitor their skin closely. While cryotherapy and topical treatments are highly effective, some lesions may be persistent or resistant. We instructed the patient to contact our office if:
The lesions fail to heal after treatment.
She experiences severe side effects, such as extensive crusting, scabbing, or redness.
For added protection, broad-spectrum sunscreen (SPF 30+), protective clothing, and limiting sun exposure are essential. In particular, patients with a history of non-melanoma skin cancers benefit significantly from daily sun protection.
Monitoring for Recurrence of Non-Melanoma Skin Cancers
Given her history of basal cell carcinoma, this patient was also advised to monitor any scars from previous excisions for signs of recurrence. Any discoloration, changes, or new bumps in these areas should be evaluated immediately, as they can signal recurrence or new growth.
During this visit, we identified an erythematous pearly papule on her left neck, a lesion of uncertain behavior that raised concerns for basal cell carcinoma. After obtaining consent, we performed a biopsy using the shave method to obtain a tissue sample for pathology. The biopsy process involved:
Preparing the area with alcohol.
Administering local anesthesia.
Using a Dermablade to perform a shave biopsy to the dermal level.
Applying Drysol for hemostasis and bandaging the area.
We will follow up with the patient regarding biopsy results within two weeks. However, we instructed her to contact our office if she has not received communication by that time.
Key Takeaways for Skin Health
Regular Skin Examinations: For patients with a history of non-melanoma skin cancer, annual or even biannual skin checks are crucial to identify any new or recurring lesions.
Sun Protection: Sunscreen (SPF 30+) and sun-protective clothing are essential for preventing new actinic keratoses and reducing the risk of skin cancers.
Monitoring Post-Excision Scars: Patients should monitor any scars from previous excisions for changes, as these could indicate recurrence.
Diet and Lifestyle: A healthy lifestyle, including limiting sun exposure, can help reduce the risk of skin cancer progression.
Conclusion
The patient’s annual examination highlights the importance of consistent skin monitoring and proactive treatment in preventing skin cancer progression. For patients in Katy, Village Dermatology offers comprehensive skin evaluations, personalized treatment plans, and ongoing guidance to help manage and protect skin health. If you have a history of sun damage or skin cancer, schedule your consultation with us today and take control of your skin health.
About the Author:
Dr. Tony Nguyen is a board-certified dermatologist at Village Dermatology, specializing in skin cancer prevention, treatment, and comprehensive skincare. Dr. Nguyen is dedicated to providing compassionate, expert care to patients in Katy and surrounding areas.
This article is intended for informational purposes only. For personalized medical advice, please consult with a qualified healthcare provider.