Actinic Keratosis Case Report: Treating a Precancerous Facial Lesion in a 92-Year-Old Patient
By: Dr. Ashley Baldree
At Village Dermatology, early detection and treatment of precancerous skin lesions is a critical part of caring for our aging population in Katy and Houston, Texas. Actinic keratoses (AKs) are common in older adults with cumulative sun exposure and require prompt evaluation to reduce the risk of progression to skin cancer.
Patient Presentation
A 92-year-old female presented as a new patient for evaluation of a changing skin lesion on the left cheek. The lesion had been present for several months and was described as darkening, enlarging, and irregular, raising concern for sun-related precancerous change. The lesion had not been previously treated.
The patient presented for full dermatologic evaluation and management.
Comprehensive Skin Examination
A full-body skin examination was performed, including the scalp, face, neck, trunk, upper and lower extremities, hands, and forearms. Dermoscopy was used to further evaluate the lesion.
The patient appeared well-developed, well-nourished, alert, and in no acute distress.
On examination, there was a hypertrophic erythematous papule with hyperkeratotic scale located on the left medial malar cheek, clinically consistent with actinic keratosis.
Assessment
Actinic Keratosis (AK) – L57.0
Precancerous lesion on sun-damaged facial skin
Treatment Plan
Given the clinical appearance and risk factors, liquid nitrogen cryotherapy was recommended and performed during the visit.
Cryotherapy Details
1 lesion treated
3 freeze–thaw cycles
Location: left medial malar cheek
Informed consent was obtained, including discussion of potential risks such as blistering, scabbing, pigmentary changes, scarring, infection, recurrence, and incomplete removal.
If the lesion does not fully resolve, shave biopsy may be considered at a future visit.
Patient Counseling & Education
The patient received thorough counseling regarding actinic keratoses, including:
Skin Cancer Prevention
Daily use of broad-spectrum sunscreen SPF 30+
Wearing sun-protective clothing
Avoiding peak sun exposure when possible
Expectations
Actinic keratoses are precancerous growths caused by long-term sun exposure
While many AKs respond well to treatment, a small percentage may progress to squamous cell carcinoma if left untreated
When to Contact the Office
If the lesion does not resolve
If new or changing lesions appear
If severe side effects occur, such as excessive crusting, tenderness, or redness
High-Quality Skin Cancer Prevention in Katy & Houston
This case highlights the importance of early recognition and treatment of precancerous lesions, especially in older adults. At Village Dermatology, we emphasize preventive care, patient education, and evidence-based treatments to help reduce the risk of skin cancer.
If you or a loved one has a new or changing skin lesion, our dermatology team is here to help.
