Skin Cancer Prevention Procedures

Actinic keratosisSkin cancer is the most commonly diagnosed cancer annually. While we are learning a lot about the disease and how to treat it, the best course of action is preventing it. Many skin cancers develop from precancerous lesions called actinic keratoses, and dermatologists perform procedures and prescribe medications that “search and destroy” these lesions before they turn into cancer. These powerful preventive procedures are recommended for patients who either currently have apparent precancerous lesions and sun damage or a history of skin cancer.

Here are a few the most common treatments that are promising to reduce the prevalence of skin cancer by stopping it in its tracks for high-risk patients:

Photodynamic therapy
This in-office treatment involves two primary agents – a topical drug called a photosensitizer (such as 5-aminolevulinic acid, or 5-ALA) that is applied to affected areas and a specific type of light.

In the first step, patients are treated with the photosensitizer, typically 1 hour prior to light treatment. The photosensitizer is absorbed by atypical cells, preparing them to be photosensitized or “activated” for treatment. In the second step, those areas are exposed to red or blue light and are selectively destroyed, causing minimal damage to surrounding normal tissue.

Photodynamic therapy is best advised for wide surface areas of sun damage, such as on the hands, forearms, face, and neck. The treatment can cause a sunburn-like reaction on the face and some swelling. Patients must diligently avoid exposing treated areas to sunlight for up to 6 weeks after treatment.

Chemical peels
Chemical peels are powerful skin exfoliants that use prescription chemicals in 3 strengths – low (or superficial), medium, and deep. These more concentrated formulas include trichloroacetic acids that produce significantly stronger peels than the over-the-counter glycolic or lactic acid “beauty peels.”

Chemical peels, in effect, strip the skin of precancerous cells, preventing the disease from taking hold. Many dermatologists prescribe the Jessner’s peel, a very effective light-to-medium-strength peel that treats wide facial areas that have precancerous lesions. Patients typically receive a series of these peels over several months.

Aside from skin cancer prevention, dermatologists use light- and medium-depth chemical peels to rejuvenate sun-damaged skin, as the peels discard damaged top layers and reveal fresh new layers. Side effects can include redness, peeling, and flaking.

Very deep acid peels using phenol are rarely prescribed or indicated as a treatment for actinic keratoses because they can be cardiotoxic. If prescribed, such procedures are performed in an operating room.

Laser resurfacing
Advances in laser therapy have redefined conventional treatment options. The new fractionated skin resurfacing lasers, such as Fraxel®, provide excellent results, generally with less “downtime” for healing than traditional erbium or carbon dioxide lasers. Fractional lasers work on the top 2 layers of skin, the epidermis and dermis, in effect “erasing” precancerous cells.

Patients may experience several days of swelling and redness, which may be followed by crusting and peeling.

Cryotherapy
Cryotherapy is a well-known treatment for actinic keratoses, with a well-documented and long history of effectiveness. The physician destroys precancerous cells by freezing lesions with liquid nitrogen. There is no excision or bleeding, and the treatment does not require anesthesia. Cryotherapy can be painful, treatment areas may blister and crust, and white spots (or hypopigmentation) may occur, especially in darker-skinned patients. Cryotherapy is most effective for smaller, isolated lesions and is not recommended for treating large areas.

I should emphasize that all of these treatments must be performed by knowledgeable and experienced dermatologists or physicians, and patients should expect to allow a week or two for post-treatment effects to subside.

If your dermatologist recommends a cancer-prevention treatment, he or she will evaluate the best procedure for your particular situation. It requires an individualized approach, depending on the nature of the lesions, the quality of the skin, the patient’s age, and personal and professional obligations. I would likely recommend very different options to a busy young professional with a few isolated lesions than I would to a retiree with more extensive problem areas and who has more time to heal.

With the exception of cryotherapy and photodynamic therapy, which are most often covered by insurance, check with your health insurance provider to determine the extent of coverage for laser and chemical peels as treatments for precancerous sun-damaged skin. Your dermatologist will provide required documentation about your specific condition, but don’t assume costs will be covered by your insurer.

Published on 09/24/2009 | Last updated on 12/20/2016