Actinic Keratosis

One of the several old man ailments I suffer is actinic keratosis, a small, scaly deformation of the skin, usually the face, arms, or hands that may develop into skin cancer over time. It is caused by having fair skin; long-term, daily sun exposure; multiple severe sunburns when young; and old age – all conditions I can lay claim to. For the past 20-plus years I’ve gone to my dermatologist, Dr. Tom, at least once a year, sometimes twice, to have him search my skin for lesions and burn off those he finds with liquid nitrogen. There’s no pain, a little discomfort, and Dr. Tom and I have a nice chat, he asking me about what I’m teaching (or now how I’m enjoying my retirement) and me asking him how his kids are doing (he has a son in med school who he hopes will take over his practice in a few years). He’s a scuba diver and an amateur underwater photographer, and we’ve talked about the barrier reef off Belize. It’s become a friendly professional relationship. About a dozen years ago Dr. Tom found something more troublesome on my upper right arm than an actinic keratosis – a basal cell carcinoma, the most common form of skin cancer. He was able to dig it out in his office – the thing I recall most vividly was the smell of my burning flesh as he cauterized the wound – and there wasn’t any spread of the cancer found in the biopsy. The only real problem with my actinic keratosis is cosmetic. For a week or so after treatment (burning off with liquid nitrogen), my face sports three or four red scars that resemble war wounds, and people who meet me stop cold and stare as if I have leprosy, asking what in the world has happened. I explain the horror easily enough. It’s just a history of being Irish and fair-skinned, playing baseball shirtless through the summer in the sun when I was young, and growing old.