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There are some skin conditions which are not cancerous, but that need to be watched, because they have the potential to become cancerous.
Actinic (or solar) Keratoses
Actinic keratoses often appear as red or brown rough and scaly patches on the skin, or hard, raised and warty patches. A few become so heaped up that they look like a small horn. They may be sensitive, and when small, easier to feel than to see. They are usually found in areas of the body that have been over-exposed to sunshine. The face, the ears, the backs of hands, and the scalps of men with thinning hair, are the most common places. They are more common in fair-skinned people. Most actinic keratoses are harmless, but in 1-2% cases they develop into squamous cell carcinoma (SCC). People with many actinic keratoses are at a greater risk of this happening. Reducing your sun exposure reduces the likelihood of the keratosis turning cancerous. Treatment is usually by cryosurgery, or sometimes with special creams. Treatment is always recommended for people who are on drugs that may suppress the immune system, because this greatly increases the risk that keratoses will become cancerous.
Bowen’s Disease
Bowen’s disease, sometimes called carcinoma-in-situ, is a very early form of skin cancer. It appears as a pink, scaly, flat area with a sharply defined border. It may be covered with crusts, or be oozy. They often grow on the legs, but they can occur on any part of the skin. Bowen’s disease of the anal or genital skin is often related to sexually transmitted infection with human papillomaviruses (HPV) (the same type that causes genital warts). If it is left untreated for many years, Bowen’s disease can spread or develop into squamous cell carcinoma. An ulcer (open sore) or a small bump coming up on the original Bowen’s disease site can be a sign of this change. Treatment is usually by surgical excision, cryosurgery or with the use of special skin creams.
Lentigos
A lentigo is an area of skin that contains an increased number of pigment cells (melanocytes). This differs from a freckle in which the number of melanocytes is normal, but the amount of pigment that they produce is increased more than in adjacent skin after sunlight exposure. There are several different types of lentigo.
The most common type is solar lentigo, caused by long-term exposure to sun, and most often seen in people over 30-40 years of age. They are commonly called ‘liver spots’ or ‘old-age spots’. They are light brown and look completely flat, similar to, but usually larger than, freckles. Unlike freckles, they do not appear and disappear with exposure to the sun. They are usually found on the back of the hands, the face and the forearms. Solar lentigos slowly increase both in size and in number as you age.
Simple lentigo usually appears first in childhood, and its cause is unknown.
Other types of lentigo can be caused by sun beds, PUVA light treatment for psoriasis, and X-rays.
Lentigo Maligna is a form of ‘in situ’ melanoma that usually occurs on the face in elderly people. It is typically a very slowly enlarging patch without any thickening, but with variation in its colour (usually medium brown but with darker brown or black areas). Sometimes, often after many years, a lentigo maligna may form a true invasive melanoma, which is then termed Lentigo Maligna Melanoma. For this reason, if you are found to have a lentigo maligna, its removal would normally be recommended. Whilst LMM needs to be treated by surgery, and this may be best for lentigo maligna, it is possible for some cases of lentigo maligna to be treated by other methods such as freezing or X-rays, and creams are being developed that may help as well.
