🩺 Case Report: Actinic Keratosis Treatment in an 81-Year-Old Female — Village Dermatology, Katy & Houston, Texas
Patient Overview
An 81-year-old female presented to Village Dermatology as a new patient with a primary concern of a bleeding skin lesion on the nose, present for several months. The lesion had not been previously treated, and she sought evaluation and management.
A complete skin exam of the head, face, ears, upper extremities, and scalp was performed with dermatoscopic evaluation.
The patient appeared well-nourished, alert, oriented, and in no acute distress.
Clinical Findings
1. Actinic Keratoses (L57.0)
On examination of the nasal dorsum, erythematous patches with hyperkeratotic scale were noted—highly consistent with actinic keratoses (AKs).
Actinic keratoses are precancerous growths resulting from cumulative sun damage. A small percentage may progress to squamous cell carcinoma, making early treatment essential.
Treatment Plan: Liquid Nitrogen Therapy
The patient underwent cryotherapy for one lesion on the nose:
Liquid nitrogen was applied to destroy the precancerous cells
Risks discussed included blistering, scabbing, hypopigmentation or hyperpigmentation, infection, incomplete removal, and recurrence
She tolerated the procedure well.
Counseling for Actinic Keratoses
The patient was educated on:
Using broad-spectrum SPF 30+ sunscreen daily
Wearing sun-protective clothing and hats
Monitoring for lesions that bleed, ulcerate, or fail to heal
Treatment options such as cryotherapy, photodynamic therapy, imiquimod, and 5-fluorouracil
Additional Dermatologic Findings
2. Benign Nevi (D22.39)
Regular, symmetrical, evenly colored moles were noted on the right cheek.
These lesions were benign and required no treatment.
Counseling Included:
Monthly self-skin checks
Monitoring for changes in size, shape, color, itching, burning, or bleeding
3. Seborrheic Keratoses (L82.1)
Benign, waxy, warty growths found on:
Right upper back
Left inframammary fold
Right lateral breast
Right proximal calf
No treatment required unless for cosmetic reasons.
4. Cherry Angiomas (D18.01)
A benign vascular papule on the left mid-back.
Counseling included cosmetic removal options such as:
Electrodesiccation
Laser therapy
5. Lentigines (L81.4)
Sun-induced brown spots found on:
Dorsal forearms
Upper sternum
Mid-back
These are benign but responsive to:
Sunscreen
Topical lightening agents
Chemical peels
Retinoids
Laser therapy
She was again counseled in detail on proper sunscreen use, including reapplication every 2 hours and using at least 1 ounce for full-body coverage.
6. Acrochordons (Skin Tags) (L91.8)
Benign skin tags present on the body; cosmetic removal was offered:
Up to 10 lesions for $150
Follow-Up
The patient was encouraged to return for evaluation if:
Any lesion fails to heal
A treated AK becomes painful, enlarging, or bleeds
New suspicious lesions appear
Routine skin checks were recommended given her sun damage history and age.
🌞 Takeaway
This case highlights the importance of early detection and treatment of actinic keratoses, especially in older adults with significant sun exposure history. At Village Dermatology in Katy and Houston, Texas, we provide comprehensive evaluation, advanced treatments, and ongoing sun protection guidance to promote healthy skin at every age.
