Prevent Skin Cancer with Topical Treatments

Actinic keratosisSkin cancer is the most commonly diagnosed cancer annually, so it is appropriate that we continue to identify the best treatments possible. But when it comes to actually preventing skin cancer, we mostly know only about the basic rules – use sunscreen, stay out of the sun, wear long-sleeved shirts and wide-brimmed hats, etc. 

But dermatologists can offer effective topical skin cancer preventives that find and destroy precancerous cells, stopping the disease in its tracks before it takes hold. These noninvasive therapies not only prevent potential cancers from developing, they may also soften lines and wrinkles at the same time. 

Let’s start with one of the best treatments for healthy skin:

Retinoids
Retinoids are vitamin A derivatives and are among the most potent rejuvenative substances we can apply to the skin. Retinoids spur increased cell turnover, effectively “remodeling” skin on a cellular level and enhancing the retention of collagen, which gives our skin elasticity and firmness. Retinoids remove the hardened uppermost layer of the skin, softening its texture, diminishing mottling, and smoothing fine lines. In my opinion, we should all regularly be using retinoids as part of a healthy skin care regimen.

As a skin cancer preventative, retinoids help normalize the skin back to a healthy state, acting almost like a potent vitamin injection, boosting the local health and efficiency of the cells that produce and control skin function. It is best to slowly work up to daily use over the course of a month or two under the direct supervision of your dermatologist. 

Don’t be confused by claims of low-strength over-the-counter retinol products. Such preparations can be expensive, and they are generally much less effective than prescription retinoids because so little of the retinol is actually processed into beneficial retinoid. For the most effective retinoid treatment, consult your dermatologist for prescription products such as Avage®, Retin-A® Micro, Renova®, and Tazorac®. You’ll get far better results – reduced fine facial wrinkles and smoother skin tone – while preventing skin cancer.

Once skin is sun damaged, signs of precancerous conditions may appear as scaly or crusty bumps, ranging in size from small (pea sized) to larger patches (quarter sized), and in color from pale to red, brown, or pink. This condition is called actinic keratosis (or AK). Millions of Americans have undiagnosed AKs. Although the exact number is not known, a certain percentage (less than 10%) of untreated AKs will develop into squamous cell carcinoma.

While there are physical treatments for AKs (to be covered in another post), there are several very effective topical treatments for AKs:

5-Fluorouracil
Prescribed as Efudex®, this powerful chemotherapy agent was developed for high-risk patients with a lot of skin damage and a history of AKs.

In twice-daily applications for 3 to 12 weeks, Efudex targets and treats AKs and basal cell carcinomas. This fast-acting, highly effective treatment is generally used on the face, arms, and chest, and it eliminates 85% of visible lesions within 2 to 4 weeks. Treatments may also have a beneficial “side effect” of more youthful looking skin, but this medication is associated with significant redness and crusting during treatment.

Diclofenac
This treatment, prescribed as Solaraze® Gel, is similar in some ways to 5-fluorouracil as an alternative topical therapy for AKs. Treatment requires about 90 days of twice-daily applications to take effect. The clear, nongreasy gel inhibits cancer cell pathways, destroying precancerous lesions and leaving clear, healthy skin. Unlike 5-fluorouracil, there is significantly less redness and crusting during treatment.

Imiquimod
This treatment works by activating the immune system to help the body destroy AKs before they become cancerous. Prescribed as Aldara®, treatment consists of twice-weekly applications left on the skin for 8 hours and then washed off. The recommended treatment course is 16 weeks, and Aldara (like all of these medications), can cause significant side effects. If your doctor recommends it, be sure to thoroughly evaluate options.

One caveat with all of these treatments is that they may cause sensitivity and side effects like redness and peeling, and individual reactions are unpredictable. Treatments must be used in tandem with a strict sun-avoidance plan. UV exposure is harmful and irritating to treated skin and can actually reverse treatment benefits. Be prepared to wear sunscreen every day and avoid being outside during peak radiation hours, between 10 AM and 3 PM.

Topical skin cancer prevention treatments have been used successfully for more than a decade. In the battle against skin cancer, it’s heartening to see such encouraging results. If you’re concerned about or at high risk of developing skin cancer, now is the time to learn about and practice prevention.

Published on 08/17/2009 | Last updated on 12/20/2016