Treatment of Nasal Actinic Keratosis 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 skin lesion on the nose that had been present for several months. The lesion was bleeding, moderate in severity, and previously untreated. Because of its chronic nature and concerning symptoms, she sought evaluation and management.
A full examination of the face, scalp, ears, and upper extremities was completed using dermatoscopy.
Clinical Findings
1. Actinic Keratoses – Nasal Dorsum
The nasal lesion revealed erythematous patches with hyperkeratotic scale, consistent with actinic keratoses (AKs)—precancerous lesions caused by chronic sun damage.
Why This Matters:
AKs are precancerous
A small percentage can progress to Squamous Cell Carcinoma if untreated
Early treatment reduces risk of skin cancer on cosmetically sensitive areas like the nose
Treatment: Liquid Nitrogen Therapy
A single AK lesion on the nasal dorsum was treated with cryotherapy (liquid nitrogen).
The patient was counseled on expected outcomes and potential side effects, including:
Crusting
Scabbing
Blistering
Temporary pigment changes
Risk of recurrence
She tolerated the procedure well.
Sun Protection Counseling
She was advised to:
Wear hats and sun-protective clothing
Reapply sunscreen every 2 hours outdoors
Avoid peak sunlight hours
These measures help prevent recurrence and reduce development of future AKs.
Additional Dermatologic Findings
2. Benign Nevi – Right Cheek
Regular, symmetrical, evenly colored moles consistent with benign nevi were noted.
Recommendations:
Monthly self-skin checks
Report changes in size, shape, color, or new symptoms (itching, bleeding)
3. Seborrheic Keratoses
Benign, warty growths seen on:
Right upper back
Left inframammary crease
Right lateral breast
Right proximal calf
These require no treatment unless irritated or desired for cosmetic removal.
4. Cherry Angiomas
A benign vascular papule was found on the left upper mid-back.
Counseling provided:
Can be removed with laser or electrodesiccation if cosmetically bothersome
No medical treatment necessary
5. Lentigines
Sun-related pigment spots found on:
Mid-back
Forearms
Upper sternum
Management options discussed:
Sun protection
Lightening creams
Retinoids
Chemical peels
Laser procedures
Sunscreen Education (Detailed)
The patient was reminded:
SPF 30 blocks 97% of UVB rays
Apply sunscreen 15 minutes before sun exposure
Reapply every 2 hours, or every 45–60 minutes when swimming or sweating
Use 1 ounce for full-body coverage
Lip balm with SPF is recommended
Sun-protective clothing is effective as long as it stays on the skin
6. Acrochordons (Skin Tags) – Cosmetic Option
Several skin tags were identified. The patient was informed she could have up to 10 removed for $150 if desired.
Skin tags are benign but may become irritated when caught on clothing or jewelry.
Follow-Up & Patient Counseling
The patient was advised to contact the office if she experiences:
Worsening bleeding
Non-healing spots
New or changing lesions
Severe irritation after cryotherapy
Regular skin checks were recommended due to her history of sun-related lesions.
⭐ Takeaway
This case highlights the importance of early diagnosis and treatment of Actinic Keratoses, especially when lesions begin to bleed or change. Through targeted therapy and thorough skin cancer screening, Village Dermatology provides comprehensive care to protect the skin health of patients in Katy and Houston, Texas.
