Laser Treatments

Actinic keratoses (AKs) are rough, scaly patches on the skin, caused by excessive exposure to the sun, that can sometimes progress into dangerous skin cancers. Doctors estimate that 40% of squamous cell carcinomas, the second leading cause of skin cancer deaths in the United States, begin as AKs. Without performing a skin biopsy, it can be almost impossible for a doctor to distinguish an AK from a squamous cell carcinoma. For this reason, 3 major medical groups- the American Cancer Society, The Skin Cancer Foundation, and the American Academy of Dermatology-all recommend that people with AKs seek treatment for them.

AKs sometimes can progress to squamous cell carcinomas. Patients may notice increased redness, tenderness, itching, and burning. However, these symptoms can be the same for either AKs or squamous cell carcinomas. This is what makes distinguishing between the two so difficult without a biopsy. Left untreated, squamous cell carcinomas may become larger, go deeper into the skin, and eventually spread to other parts of the body. This results in thousands of skin cancer deaths each year, many of which could be prevented.

It is impossible to predict if an AK will evolve into a squamous cell carcinoma, or at which point it will happen. Many doctors believe that AKs and squamous cell carcinomas are really the same condition at different stages of a continuing process. This process begins with minor cell damage and, over time, ultimately results in the cell becoming cancerous. In other words, AKs occur in the early stages of the process; squamous cell carcinomas occur in the final stage. A significant percentage of AKs develop into squamous cell carcinomas. Estimates range from 10% to as high as 20% over a 10-year period.

Long-term exposure to the sun is the single most significant cause of AKs, so the best defense against them is a comprehensive sun protection program. This includes wearing protective clothing and a wide-brimmed hat, avoiding the sun at midday when ultraviolet rays are strongest, staying in the shade as much as possible, and wearing a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 15.

In our office, a medication called Levulan is applied to the area of sun damage (actinic keratoses). After one hour, the solution is absorbed by the damaged cells. The area is then exposed to the Blue Light, which causes a chemical reaction destroying the cells. After the damaged cells are destroyed, healthy new cells replace them.

The Levulan that was applied to your skin in the office is still active for 48 hours after the initial application. Any exposure to sunlight (even through a window) will cause inflammation and irritation. In the Naples area, this can be difficult. For this reason you cannot participate in any outdoor activities (golf, tennis, a walk outside) for two days following the procedure. You should wear sunscreen, a hat and sun protective clothing, even when inside, for two days following the procedure. Although results will vary, most people experience redness and mild pealing for up to ten days following the procedure. Excessive redness, swelling or crusting will occur if the post procedure instructions are not followed.

The blue light should be scheduled at a time when you do not have outdoor activities planned for two days. Also, it should not be scheduled less than ten days before a special event as there will be some redness.

On the day of the procedure come to our office without moisturizer, sunscreen or makeup. Please bring a sunscreen with an SPF of 30 or greater with you. If you do not bring your sunscreen you will need to buy one at our office. Please bring a book, crossword puzzle, magazine or other diversion as there will be a one hour wait after the Levulan is applied.

Wash the area with a gentle cleanser such as Cetaphil. Use a sunscreen with an SPF of 30 or above even when you are not planning on going outside. We suggest a sunscreen that contains zinc or titanium. Appropriate sunscreens are available for purchase in our office. If your skin is very irritated, use an over the counter 1% Hydrocortisone Cream twice a day. If this does not relieve your discomfort we can give you a prescription for a stronger cortisone cream.

Do “Blue Light” treatments replace liquid nitrogen, Efudex, Carac and Aldara? Blue light will hopefully minimize the needs for these other treatments. However, they may still be necessary for thicker lesions or stubborn areas.

The blue light treatment for actinic keratoses is covered by Medicare and Blue Cross Blue Shield of Florida. We would be happy to pre-approve your treatment to confirm coverage for any other insurance company.