I’ve had these marks on my forehead and temples for a couple years now. They’ve not looked that bad, and I figured they were just some sort of aging spots since I’m in my 60s, but I finally went to see a dermatologist late last month. He said they were actinic keratoses, pre-cancerous skin growths that could, if left untreated, develop into squamous-cell carcinoma. Maybe a 20% chance. He treated them on the spot with liquid nitrogen and gave me a prescription for Fluorouracil topical cream USP 5%.
I’m supposed to use the cream for seven “cycles,” a cycle being seven consecutive days per calendar month. The doc said the anointed skin would turn red but that the redness would go away 7-10 days after I stopped using the cream at the end of a cycle. Today was the end of my first cycle. The keratoses themselves are very red now – someone this afternoon asked me if I had burned my forehead – but not so much the skin surrounding them. A little red but not much.
I’m going to assume the keratoses’ redness at the moment is due to the cream and not the liquid nitrogen, as the latter was a full ten days ago. My next visit with the dermatologist is not until mid-November, when he plans to do a full-body check, so I’ll have done four cycles by then.
He also recommended something sold by Foundation Skincare called Spectrum antioxidant vitamin supplement, containing nicotinamide, vitamin D, milk thistle and polypodium leucotomos extract.He pointed out to me the part in the link above that says: “In a key trial published in the New England Journal of Medicine (N Engl J Med 2015; 373:1618-1626), patients with a history of non-melanoma skin cancer were treated with nicotinamide at the same dose as found in SpectrumRx for one year or a placebo. The group receiving the nicotinamide had a 23% reduction in new skin cancers during the year as compared to patients receiving placebo.” So I ordered a bottle to try it, $65 for a two-month supply. I was impressed that it arrived here in Hawaii only three days after ordering it, and that’s with free shipping. But I cannot take it yet, as I have shoulder surgery this coming Friday the 13th – no, I’m not superstitious – and my surgeon has me stopping all vitamins and supplements until afterward.
I was just wondering if anyone here has experience with actinic keratoses and their treatment.
A ginger friend has had a lot of experience with these. She is especially sensitive to the Fluorouracil topical cream. Her face looks like a stop sign when she is using it.
I’ve had experience diagnosing AKs as a pathologist.
The figure your dermatologist gave you for risk of development into squamous cell carcinoma sounds a bit high - more commonly it’s cited as a 10% risk or less. For instance:
“A systematic review found that the estimated risk of a single AK lesion becoming malignant ranged between 0.075% and 0.096% per year, or approximately1% over 10 years, with some estimates as high as 10% over 10 years (2). In another review the risk of progression of AK to invasive SCC varied between 0.025% and 16% per year (12).”
There is some evidence indicating oral nicotinamide may be helpful in preventing AKs. The specific supplement recommended to you uses a so-called “proprietary blend” which obscures what dose of nicotinamide is said to be in the product. Nicotinamide a.k.a. niacinamide (which is basically a water-soluble form of vitamin B3) is available much more inexpensively. One seller offers 100 capsules containing 500 mg. of nicotinamide for $6.99. You could check with your dermatologist regarding dosage and whether the supplement he recommended has documented virtues other than the nicotinamide.
I’ve used the stuff but the derm warned me to NOT follow the instructions but use it once a week until the mark went away. It was next to my upper lip. I was daring and used it twice a week and the mark did go away.
I’ve actually got several AKs that were frozen off and have come back. They are not on my face. I need to find a new dermatologist as the previous one has moved elsewhere.
I was immunosupressed for a few years, and that increases your chances of getting them. I had two - one resolved spontaneously, but the other had to be treated. I was recommended not to use Fluorouracil topical cream because it can make a mess of your face; so I used Solaraze (3% diclofenac gel) - and that made a mess of my face instead. In the end they nitrogened it off and that was the end of it.
Hmm. That’s a thought. I might try that after the current cycle dies down. It’s no fun looking like a burn victim. Yesterday, just two days after my last application in the cycle, the effect had worn off enough to where I only looked like a leper, so it does wear off quickly. My doctor said the goal was for it to be red but not look like raw hamburger and to stop using it if it progressed that far. I might try this once or twice a week too for a month and see what happens.
Could the risk be higher here in the tropics? As for the nicotinamide, the doctor did first mention a cheaper alternative that was (I think) available locally. From Biophix, it is solely B-3 nicotinamide, 500mg, a 50-day supply (100 capsules) for $28.89. No doubt I can find it cheaper. But then he brought up what I ordered and said that was the really good stuff and was what he recommended. I’ll take the stuff I ordered while doing some more research.
Thanks to all for your comments. They are appreciated, every one of them.
Did the shoulder surgery yesterday – hurts like a motherfucker and am typing with one hand today – so I’ve started up vitamins again including the Spectrum supplement I mentioned above. The instructions on the label says, “If taking a statin medication, limit dosage to one (1) capsule daily” instead of the regular two capsules. I do take a statin, Atorvastatin, for cholesterol. So my two-month supply just turned into a four-month supply. A better deal.
Glad to hear. I have been told by both dermatologists and patients that using it every day makes the skin around it look like raw meat. Now, if that’s someplace where I can easily pop a bandage over it fine. But the upper lip is pretty tricky, and I’d never get kissed again.
I used it as the doc directed in August. Supposed to be seven consecutive days each calendar month through January. Except stop if it starts turning the skin into raw hamburger. Mine was turning into raw hamburger, so I stopped after five days. Forehead and both temples, so that was noticeable, and I was getting some odd looks.