COLUMN: The art of reflection
Only solitary men know the full joys of friendship. Others have their family; but to a solitary and an exile his friends are everything.
-Willa Cather, Shadows on the Rock
THE MEN’S HEALTH ADVISER BY AARON SMITH
Men’s skin: more often than not it gets abused and ignored. Too much sun and not enough sunscreen. Most of us are guilty.
One of the most common sun related skin issues that bring men into my office are actinic keratoses. These are red and scaly flat skin splotches that will normally vary in size from a few millimetres to a couple of centimetres in diameter. With time some may form a thick yellowish scale on a red skin base, and some even progress to form a cutaneous horn (a cone-shaped extension of hard crusty material which may protrude from the skin up to 1-2 cm).
Actinic keratoses are caused by sun exposure and are most likely to occur in areas where sun exposure is highest; for example the backs of the hands, forearms, brow and temple area, tops of the ears, and the top of the head if you are bald or balding (interestingly, I have noticed that actinic keratoses tend to occur more on the left arm and hand, probably because this is the one usually hanging out the car or truck window). They tend to occur most on people with fair complexions and tend to be particularly common in people who work outdoors. We also know that having six or more bad sunburns in one area will really greatly increase the risk of getting an actinic keratoses in that area. About 11 to 26 per cent of the North American population will be affected by at least one of these lesions. In my office, I tend to see actinic keratoses much more often in men than in women.
Actinic keratoses are a concern because although most will not cause trouble other than cosmetically, some may progress to a form of skin cancer called squamous cell carcinoma, or SCC for short. If left untreated, SCC can spread into deeper tissues underlying the skin and be a serious health issue. The difficult part is that although most actinic keratoses will not turn into SCC, it is impossible to tell which ones may cause trouble eventually. For that reason, primary care physicians and dermatologists will often treat these lesions to prevent SCC from happening.
The most common treatment for actinic keratoses is cryotherapy (or liquid nitrogen therapy). Often times this can be done right in your primary care provider’s office. Cryotherapy is particularly good at treating isolated, relatively thinner lesions. Individual treatments take literally seconds and are usually associated with only some mild localized discomfort. Thicker lesions may need a few applications. Properly applied, cryotherapy has a 70 to 90 per cent cure rate.
More widespread lesions may need a cream-based treatment usually applied over the course of a few months. If there is any question about the diagnosis, or any concerning features, your health care provider may want to excise (cut out) the lesion with some local freezing and then send the tissue to a pathologist to pin down the diagnosis. There are other much more uncommon treatment options such as shave excisions, dermabrasions, and chemical peels, but these are seldom used in clinical practice.
If you notice any spots on the skin that seem to be actinic keratoses (red, scaly, and flat) get them checked out by your primary care provider, especially if they are greater than 1cm in diameter, have a scabby appearance, are tender, or are rapidly growing. If caught early, actinic keratoses can be easily treated and this keeps the risk of trouble low.
The bottom line is this: if you want to avoid developing actinic keratoses and other potentially dangerous sun-related skin lesions, wear sunscreen (at least SPF 25). If you can’t avoid sun exposure during the peak UV hours (11 a.m. to 3 p.m.) then cover up the skin and use broad-brimmed hats (ball caps tend to leave the temple areas and ears exposed to sun damage). Also, when fishing or boating, remember about the reflection up from the water and use some sun screen on your face even if wearing a hat.
Aaron Smith is a family physician practising in Westville, Nova Scotia with a background in community health and epidemiology. This column is intended to provide general information only. Always consult your primary health care provider for specific information on personal health matters.