If you’ve noticed a small spot or rough patch on your skin that doesn’t seem to be clearing up, don’t just ignore it. It could be pre-cancerous.
I’m someone who takes the "pale and interesting" look to the limit: sunlight is a blight as far as I’m concerned, and I’d prefer it if summer were permanently cancelled. I hardly ever go out in the middle of the day, and if I do I slather on so much sun block I look like I’m about to swim the English Channel. Fully clothed.
The point being: no-one takes sun protection more seriously than I do.
So when a small, rough, painless patch, obvious only to myself, appeared on my upper lip, it was easy to pretend it was nothing. And to continue to pretend for months.
When a spot won't heal
The one thing I couldn’t ignore, though, was that the patch would periodically peel, seem to heal, and then become rough again. And even the most clueless health journalist knows that something that doesn’t heal is a Worrying Sign.
Also (and I tried very hard not to think about this), my mother, and my grandfather before her, had developed localized skin cancer in almost exactly the same spot on the upper lip.
Eventually, and somewhat sheepishly because it had taken me so long to get around to it, I took the offending patch to my GP. She took one look at it, and pronounced: “Solar keratosis,” and then added cheerfully, “You’re in luck – it’s liquid nitrogen day!”
What is solar keratosis?
Solar keratosis (also called actinic keratosis; plural keratoses), which I’ve euphemistically referred to as "sun spots", is a pre-cancerous growth caused by long-term sun exposure. It’s common in fair-skinned people living in sunny climes like South Africa and Australia.
The condition becomes more common after age 40 – but may even occur in your 20s and 30s, especially if, like me, you didn’t practise proper sun protection in your youth – and the risk continues to rise with age.
Solar keratoses range from barely perceptible rough spots a few millimetres in diameter, to harder patches several centimetres in diameter. They may be flakey or scaly, may peel, and don’t heal properly. They may be a different colour to the surrounding skin, but early keratoses are often easier felt than seen.
They occur more commonly on areas of the skin that have received repeated sun exposure, such as the face, ears, bald scalp, neck, shoulders, forearms and backs of the hands.
If left untreated, there is a risk that solar keratosis can progress to become squamous cell carcinoma, a type of invasive skin cancer. This is a slow-growing cancer which can usually be effectively treated, but if left for too long it can be disfiguring and has the potential to spread to other parts of the body and even prove fatal.
Squamous cell carcinoma, into which solar keratosis can develop
The good news is that solar keratoses can be effectively treated.
A solar keratosis is usually removed, as mine was, by freezing it with liquid nitrogen. This is a quick, inexpensive procedure. It's a bit painful, causing a burning sensation, but this doesn’t last long. My treatment resulted in a small, unobtrusive blister on the treated area, which peeled off after a few days, leaving a reddened mark. Two weeks later, the skin was completely clear.
If the condition is more extensive i.e. there are several growths, a medicated cream is the likely treatment. This causes redness and scaling as part of the treatment process, which makes the skin look worse – but only temporarily.
If the keratosis is unresponsive to treatment, or recurs, your doctor may decide that a biopsy is necessary to rule out skin cancer.
You know the drill: avoid the sun between 9am and 3pm, especially in summer; wear a high factor sunscreen and cover up with long sleeves, a hat and good sunglasses.
But you also need to get well acquainted your skin, every inch of it. Most people know the importance of keeping an eye on the heavily pigmented spots (e.g. moles), but you need to extend that scrutiny to ANY suspicious spots.
A good idea for keeping track of moles and and other possible "sun spots" is to photograph them periodically, then compare the pictures for any changes. Don’t forget about those bits you don’t usually see, like your back: get a partner or friend to check on the spots you can’t easily see in the mirror.
Many studies indicate that a healthy lifestyle generally – a diet low in animal fats and high in fruits and vegetables, getting enough rest and exercise and avoiding tobacco smoke – helps protect against cancer, skin cancer included.
- Olivia Rose-Innes, EnviroHealth Editor, Health 24, updated January 2013
NOTE: Since writing this article, I developed a second solar keratosis in almost exactly the same area, and it received the same effective treatment. Your risk for skin cancer is higher if you have had a previous lesion, making it all the more important to keep a vigilant watch. An annual check by a dermatologist is recommended for everyone with paler skin tones, spots or no spots.
The Merck Manual of Diagnosis and Therapy, 19th edition, 2011
I survived skin cancer