Treating Actinic Keratosis and Squamous Cell Carcinoma in Older Adults: A Real Patient Story from Houston and Katy
Article by Dr. Ashley Baldree
At Village Dermatology, we often see patients in their later years with skin changes due to sun exposure over a lifetime. One recent patient, an 88-year-old man, came to us with darkening, enlarging lesions on his scalp that had become irregular over time. These skin changes were concerning not just because of how they looked—but because they could be signs of precancerous or cancerous skin growths.
In this blog, I’ll share how we evaluated and managed his condition, and what this case can teach us about actinic keratosis (AK) and squamous cell carcinoma (SCC) in older adults.
The Patient's Visit: Evaluation and Diagnosis
This gentleman had multiple lesions on his scalp and cheek that had changed in size and color. These are classic warning signs for sun-related skin damage. During his exam, we noticed scaly, red patches and thickened nodules—findings that led us to diagnose both actinic keratoses and biopsy-proven squamous cell carcinomas.
We used a dermatoscope, a special magnifying tool, to closely inspect the lesions. His overall health was good, and he was fully alert and oriented—key factors when planning treatment in older adults.
What Are Actinic Keratoses?
Actinic keratoses (AKs) are precancerous skin lesions caused by chronic sun exposure. They often appear as rough, red or pink patches and are common on the scalp, face, ears, and hands—especially in fair-skinned individuals.
These spots can turn into squamous cell carcinoma if left untreated, though not all do. That’s why it’s important to treat AKs early. For this patient, we treated 10 AKs using cryotherapy, where liquid nitrogen freezes the lesions, causing them to crust and fall off naturally over a few weeks.
We also counseled him on:
Wearing broad-spectrum sunscreen SPF 30+ daily
Using sun protective clothing
Regular follow-ups to check for new or changing lesions
Learn more about AKs and skin cancer at Village Dermatology's Skin Cancer Education Page.
Diagnosing and Managing Squamous Cell Carcinoma (SCC)
This patient also had two areas on his scalp that were confirmed by biopsy to be well-differentiated squamous cell carcinomas. SCC is a common type of non-melanoma skin cancer and can become more serious if not addressed.
We discussed treatment options including:
Mohs surgery (a highly precise surgical technique)
Surgical excision
Radiation therapy (XRT)
Although Mohs surgery is our standard for high-risk areas like the scalp (due to precision and low recurrence rates), the patient declined surgery and opted for radiation therapy instead. We coordinated with his primary care provider for referral to a radiation oncologist.
This type of shared care ensures that the patient gets treatment tailored to his preferences and health status while also addressing the seriousness of his diagnosis.
Learn more about SCC and treatment choices on our site:
Basal and Squamous Cell Carcinoma Treatments
Key Takeaways from This Case
✅ Sun damage is cumulative—what we did decades ago can show up now.
✅ Actinic keratoses are warning signs and should be taken seriously.
✅ Squamous cell carcinoma is treatable, especially when caught early.
✅ Radiation therapy can be an option for patients who can’t or prefer not to undergo surgery.
✅ Personalized care matters, especially in older adults with specific health goals.
At Village Dermatology in Katy and Houston, we’re committed to delivering expert, compassionate care for every age. If you have changing skin lesions or a history of sun exposure, schedule a skin cancer screening with us.