Dr. Shanza Ikram
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a fair-skinned 32-year-old woman. I have used skincare with SPF for as long as I can remember and have never burned. For 1.5 years, I have had this little patch on my hairline. I think it started as a pimple, but I am not sure I could be wrong. It has been visible for all this time, but recently, I must have punched it, so the dry skin came off, and it started bleeding. It is not healing properly, but I do keep picking. When cured, it blanches when pressed with a glass. My question is, could this be a squamous cell or basal cell carcinoma if it blanches when using a glass? It also never grew in and is flat. Many thanks for considering my request. Kind regards.
Hi,
Welcome to icliniq.com.
I have gone through the case. Well, according to your description, my opinion is that it could be Actinic keratosis. Actinic keratosis is also one of the conditions that occur in fair colored individuals and sun-exposed areas like the face or arms. Its typical features are dry, irregular patches with scales, and when scales are removed, there are small bleeding points. And you have described very typical features. So, in my opinion, it could be Actinic keratosis. It is a premalignant condition, and slowly over many years, it can develop into carcinoma. Now your questions about squamous cell carcinomas or basal cell carcinoma. You need to understand that you have not sent any pictures. So I have given you a diagnosis on your description only. But for confirming the diagnosis and differentiation, you need a detailed examination first and then a biopsy. I hope I have made it clear to you. Take care.
Patient's Query
Hi doctor,
Thank you for your very fast and knowledgeable reply. I will attach a photo of what the patch had looked like for a long time before I picked it and a scale (one, the size of the patch) fell off. It is a relatively small (2 mm), flat patch on my forehead. I picked it, so it is red, but I will attach a photo of its usual appearance. Thank you again. Kind regards.
Hi,
Welcome back to icliniq.com.
I have seen your picture (attachment removed to protect patient identity). And yes, it is actinic keratosis. For treatment, regularly apply sunblock; you have already used it. Take sunblock with a high sun protection factor-like 60 or 100. Apply Vaseline over it. Apply Retinoid like Adaplene at night only on lesions. You need a follow-up examination after six months. Take care.
Patient's Query
Hello doctor,
Thank you very much for your reply. So, it is not a skin cancer (I know AK is pre-cancerous). I always use a factor of 30 to 50, but I will go higher. I wonder, since I am breastfeeding (my daughter is a toddler, not a baby), can I apply retinol very locally, just on the spot? I have wanted to use over the counter face creams with retinol, but I waited until she stops. Kind regards.
Hi,
Welcome back to icliniq.com.
And extremely sorry for being late. Yes, use sunblock with high SPF. Use other sun protection measures like a hat, sunglasses, and full sleeves of shirts. These are called a physical barrier. Use retinol only at night and on an alternate night. Take a minimal amount of it. Yes, as you require only a small amount, you can use only on the lesion. But, not apply on the whole face. Retinoid, when taken in large amounts, or if you go for cooking or heat exposure, then it may cause burning. So remember to take a minimal amount only at night while sleeping and apply sunblock during the day. Take care.
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