Dr. Rockoff received his undergraduate degree from Yeshiva College with the distinction of Summa Cum Laude. He received his medical degree from the Albert Einstein College of Medicine. His internship and two years of Pediatric residency were at the Bronx Municipal Hospital Center, followed by training in Dermatology at the combined residency program at Tufts and Boston Universities. Dr. Rockoff is certified by both the American Board of Dermatology and the American Board of Pediatrics.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Actinic keratoses (AKs) are small, red, rough, scaly, flat spots that feel like dry skin patches. They often occur on sun-exposed areas, such as the nose, ears, face, chest, forearms, and back of the hands. Other common names include AK, AKs, solar keratosis,
precancers, and pre-skin cancers.
At what age do AKs develop?
Experts agree that AKs are most common in older adults and seniors. AKs are extremely rare in children or adolescents.
What are my chances of my precancers becoming skin cancers?
Anywhere from 5%-10% of AKs can potentially go on to become skin cancers. It is not possible to tell which ones will do this. Some AKs will never develop into anything else. Some AKs go away without treatment.
Do actinic keratoses ever turn into melanoma (a deadly form of skin cancer)?
No. While AKs may give rise to skin cancers like squamous cell carcinomas, they do not turn into melanomas. Nevertheless, it is important to keep in mind that people with AKs may be more prone to melanomas simply by having more sun damage.
What is an actinic keratosis, and what does it look like?
An actinic keratosis (AK), also known as a solar keratosis, is a small, rough
spot occurring on skin that has been chronically exposed to the sun. Actinic
keratoses generally measure in size between 2-6 millimeters in diameter
(between the size of a pencil point and that of an eraser). They are usually
reddish in color, with a rough texture and often have a white or yellowish scale
on top. Actinic keratosis often occurs against a background of sun damage,
including sallowness, wrinkles, and superficial blood vessels.
In addition to feeling rough, actinic keratoses may feel sore or painful when
fingers or clothing rub against them.
Specialized forms of actinic keratoses include cutaneous horns, in which the
skin protrudes in a thick, hornlike manner, and actinic cheilitis, which refers
to scaling and roughness of the lower lip and blurring of the border of the lip
and adjacent skin.
Who is at risk for an actinic keratosis?
Those who develop actinic keratoses tend to be fair-skinned people who have spent a lot of time outdoors at work or at play over the course of many years or who have exposed their skin to indoor tanning. Their skin often becomes wrinkled, mottled, and discolored from sun exposure. Others at risk for developing actinic keratoses include those who have their immune systems suppressed, such as organ transplant patients, as well as patients with psoriasis treated with PUVA therapy (topical long-wave ultraviolet light plus oral chemicals called psoralens.)
Where on the body do actinic keratoses typically occur?
Common locations for actinic keratoses are the face, especially the cheeks and bridge of the nose, scalp, back of the neck, upper chest, as well as the tops of the hands and forearms. Men are more likely to develop AKs on top of the ears, whereas women's hairstyles often protect this area. AKs, especially on the scalp and the backs of the hands, may be hypertrophic
(thickened skin).
What is the significance of an actinic keratosis?
Actinic keratoses are precancerous (premalignant), which means they can develop into skin cancer. However, relatively few of them actually become cancers, a process that typically takes years. When a malignant change does occur, the cancer is called a squamous cell carcinoma. Although squamous cell skin cancers have the potential for metastasis (spreading to other areas), such cancers that arise in preexisting actinic keratoses have a low potential for such spread, and only do so once they have gone deeper and the skin and become invasive. Treating actinic keratoses at an early stage helps prevent this possibility.
When patients are diagnosed with this condition, they often say, "But I
never go out in the sun!" The explanation is that it takes many years or
even decades for these keratoses to develop. Typically, the predisposing sun
exposure may have occurred many years ago. Short periods of sun exposure do not
generally either produce AKs or transform them into skin cancers.
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.
Skin cancer is the most common form of cancer
in humans. There are three main types of skin cancer; basal cell carcinoma and
squamous cell carcinoma (the nonmelanoma skin cancers), and melanoma.
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk for scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) include nausea, fever, chills, rapid pulse, dizziness and more. Treatment for sunburn depends upon the severity. Sun protection and sunscreen for an individual's skin type is recommended to decrease the chance of sunburn.
Wrinkles, whether they be fine line or deep furrows, typically appear on areas of the body that receive a high amount of exposure to the sun. Smoking, light skin type, hairstyle, the way you dress, your occupational and recreational habits, and heredity are all factors that promote wrinkling. Medical treatments for wrinkles include antioxidants, moisturizers, alpha-hydroxy acids, and vitamin A acid. Cosmetic procedures that treat wrinkles include dermabrasion, microdermabrasion, glycolic acid peels, laser resurfacing, Botox, and fillers.
What are noninfectious, common rashes localized to a
particular anatomical area?
Common, noninfectious rashes are listed below. Since these conditions are not caused by infectious organisms, it is reasonable to attempt to treat them with
over-the-counter 1% hydrocortisone cream for a week or so prior to seeking medical attention.
Seborrheic dermatitis: Seborrheic dermatitis is the single most common rash affecting adults. It produces a red, scaling eruption that characteristically affects the scalp, forehead, brows, cheeks, and external ears.
Atopic dermatitis: Atopic dermatitis, often called eczema, is a common disorder of childhood which produces red, itchy, weeping rashes on the inner aspects of the elbows and in back of the knees as well as the cheeks, neck, wrists, and ankles. It is commonly found in patients who also have asthma and hay fever.