As we age, our bodies start acting in different ways. In some cases, less efficiently in a number of areas, one of which is the skin! Which means that if you’re 65 and over, you may experience skin conditions not present or more frequent than in your younger years.
Here to help us understand what you may need to keep a closer eye on is Dr. Shannon McKeen, Medical Director for Apex Skin, and practicing dermatologist in our Cuyahoga Falls office.
Actinic Keratoses (AKs)
Some skin conditions you may once have ignored with the hopes of them healing on their own may be more damaging than expected as you age. One of those happens to be actinic keratoses.
What are AKs?
Actinic keratoses (AKs) are precancerous growths on the skin. They are caused by sun damage to the skin over a person’s lifetime. AKs have the potential to develop into a squamous cell carcinoma.
“More than 40 million Americans develop AKs each year. AKs present as dry, rough, scaly (sandpaper-like) patches on the skin. They can be pink, red, white, flesh-colored or brown.”
Where are you most likely to see them?
“AKs are most commonly found on sun-exposed areas, such as the face, ears, scalp, chest, and tops of hands. However they can be seen anywhere on the skin.”
This is why it’s important to have your skin checked at least once a year, in case they appear in areas you’re not expecting.
How are AKs treated?
“There are many therapeutic options for AKs including cryotherapy (liquid nitrogen), topical chemotherapy creams (5-FU, imiquimod, diclofenac), photodynamic therapy, chemical peels, laser resurfacing, and curettage. Depending on the number of AKs you have, the thickness of the lesions, the sites involved and other factors, your Dermatologist will formulate a treatment plan for you.”
Skin Cancer
This is another common skin condition found in many people over a certain age. The older we are, the longer our skin has been impacted by environmental factors like the sun, increasing the risks of skin cancers.
Let’s break them down, along with the differences in the types and how to treat them.
Why does skin cancer happen more often as we age?
Skin cancer is most commonly seen in patients 50 years of age and older. However, we are recently seeing a rising rate of skin cancers in individuals younger than 50 years of age.
“When UV light hits our skin, it can damage the keratinocytes (outermost layer of the skin). Over time and repeat exposures, the damage builds up causing mutations in the cells to develop, leading to precancerous lesions or skin cancer. Therefore, with time and cumulative sun exposure, rates of these lesions rise as we age.”
Basal Cell Carcinoma
Let’s dive into the different types of skin cancer, their severity, and what you can do to prevent and even treat them.
How common is basal cell?
Basal cell carcinoma (BCC) is the most common form of skin cancer. An estimated 3.6 million cases of BCC are diagnosed in the United States each year.
Where are you most likely to see them?
“Basal cell carcinoma most commonly presents on sun-exposed skin, such as the face, neck, chest, forearms, and shins. However, BCC can present anywhere on the body.”
What do they look like?
A basal cell carcinoma can present in a variety of ways. BCC can look like a pink bump, a pink to red scaly patch, scab or sore that does not heal, or a white spot or scar-like lesion.”
If you have any area of concern, it is best to have the lesion evaluated by your Dermatologist.
How are they treated?
Treatment of BCC depends on the size, location, and pathological subtype of the lesion. Surgical options include Mohs micrographic surgery (highest cure rate), wide local excision or electrodessication and curettage. Non-surgical options include radiation therapy, cryotherapy, or topical chemotherapy creams.
Squamous Cell Carcinoma
This skin cancer is what we consider #2 of the big three we’re covering.
How common is squamous cell carcinoma?
Squamous cell carcinoma (SCC) is the second most common form of skin cancer. Approximately 1.8 million cases of SCC are diagnosed in the United States annually.
Where are you most likely to see them?
“SCC most commonly occurs in high sun-exposed areas of the skin, such as face, scalp, ears, and hands. However, SCC can occur anywhere on the body, especially in patients with a history of immunosuppression.”
What do they look like?
Squamous cell carcinomas can have a variety of presentations including a red rough scaly patch, open sores that do not heal, tender red bump on the surface of the skin, or a warty or horn-shaped growth.
How are they treated?
Treatment of SCC depends on the size, location and pathological subtype of the lesion.
“Surgical options include Mohs micrographic surgery (highest cure rate), wide local excision or electrodessication, and curettage. Non-surgical options include radiation therapy, cryotherapy, or topical chemotherapy creams.”
Melanoma
When you think of deadly skin cancer, this is likely the one you think of most often, since Melanoma is the most dangerous of skin cancers.
How common is melanoma?
“According to the Skin Cancer Foundation, it is estimated that 186,680 cases of melanoma will be diagnosed in the U.S. in 2023.”
What does melanoma look like?
“We counsel patients to look for the ABCDE’s of melanoma. If any of the following arise in your moles, that should prompt patients to call their Dermatologist for evaluation.”
- Asymmetry: when one half of the lesion does not look like the other half
- Borders: irregular borders or jagged edges of the mole
- Color: multiple colors within the same mole or the pigment is not uniform
- Diameter: larger than 6mm (pencil eraser) is a concerning feature, however some melanomas can be smaller
- Evolving: any change in size, shape, appearance or symptoms of a mole over time
If you notice any of these signs, schedule a skin check to catch this skin cancer early.
Where are you most likely to get melanoma?
“Melanoma can occur on either sun-exposed or sun-protected skin. In women, melanomas occur most commonly on the legs. In men, melanomas occur most commonly on the trunk.”
How is melanoma treated?
Treatment of melanoma depends on the depth of the melanoma in the skin and whether it has spread to other areas of the body.
“Melanomas are commonly treated by surgical excision. Some melanomas require a lymph node biopsy. If the melanoma is deep in the skin or has spread to other areas of the body, the patient may need treatment with chemotherapy, immunotherapy, or radiation.”
What can I do to prevent skin cancer at my age?
Sun damage is cumulative over your lifetime. We cannot go back and undo the UV damage that has occurred in the past, but it is important to be diligent about our sun protection moving forward.
Here are some steps you can take:
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- Wear sun protective clothing: broad-brimmed hat, sunglasses with UV protection, clothing with ultraviolet protection factor (UPF).
- Wear sunscreen daily (even on cloudy days) and re-apply every two hours: sunscreens should SPF 30 or above and broad-spectrum
- Seek shade when able: the sun’s rays are strongest between 10 a.m. and 2 p.m.
- Be cautious of reflective surfaces: Use extra caution near water, snow, and sand because the reflection can cause sunburns
- Avoid tanning beds
- Skin exams: Perform routine self-skin exams and get an annual (unless instructed more frequently) skin check with a dermatologist
Other Common Skin Conditions as We Age
Let’s take a look at a few more common skin conditions most people will face as they age.
Seborrheic Keratoses
What are seborrheic keratoses?
Seborrheic Keratoses (SKs) are common, benign growths. They present as well-demarcated waxy or flaky plaques that can be white, tan, or brown in appearance. These lesions present in mid-adulthood and increase in number with age.
Are they dangerous?
“Although the appearance of SKs can sometimes be concerning to patients, they are not dangerous. However, because they are raised off the skin, SKs can become a source of itching or irritation to the patient.”
How can they be removed?
Seborrheic keratoses can be removed by cryotherapy (liquid nitrogen) or electrocautery.
Cherry Angioma
What is a cherry angioma?
Cherry angiomas are benign vascular proliferations which are commonly seen on the trunk and upper arms. They appear as bright red to purple smooth, dome-shaped papules.
Is it dangerous?
These lesions are benign and do not require treatment unless irritated or bleeding.
How can they be removed?
These lesions can be treated with a vascular laser, shave removal, or electrodessication.
Skin tags
What are skin tags?
“Skin tags, also known as acrochordons, are common benign cutaneous growths. They present as flesh-colored to brown, soft papules. These lesions are most commonly found in areas of friction, such as the neck, axilla, inguinal folds, and eyelids.”
Can they be removed?
Skin tags require no treatment. However, they can be removed easily in the office if either physically or cosmetically bothersome to the patient.
“Treatment options include mechanical snipping, cryotherapy, or electrocautery.”
While all of these skin conditions are common as you age, they can all be treated in order to manage and maintain skin health. Make sure to schedule your appointment to check and treat these ailments, and get a full body skin check at least once each year.
Dr. McKeen is a doctor and the Medical Director here at Apex. She’s originally from South Bend, Indiana. She completed her undergraduate years at Ball State University, and as a chemistry/pre-medicine double major, won awards for Excellence in Undergraduate Teaching and Performance in Chemistry.
Dr. McKeen attended medical school at Lake Erie College of Osteopathic Medicine, where she was one of two students in her graduating class to receive the Academic Achievement Award.
She spent her clinical years at University Hospitals Richmond Medical Center, and after medical school, stayed to complete a Dermatology-focused Traditional Rotating Internship. She completed her Dermatology residency at Lakeland Health in Saint Joseph, Michigan where she was appointed chief resident. After completion of her dermatology residency, she became board certified by the American Osteopathic Board of Dermatology and gained Fellowship status from the American College of Osteopathic Dermatology.
