Clinical Appearance of Sun Damaged Skin

The appearance of sun-damaged skin is well recognized and is different from changes seen with normal chronological aging. The very smooth, fine, pale wrinkling associated with aging seen in the sun-protected areas of the skin such as the buttocks are different from those of sun damage.

Fine and coarse wrinkles are seen on sun-damaged skin. There is a roughness to the skin and a laxity or looseness in advanced damage. Patchy or mottled darker patches of increased pigmentation are seen. Sometimes these patches become irregular and produce what are known as lentigos. In areas around the back of the neck a leathery texture and coarseness with deep lines is frequently seen. The skin may feel dry and scaly. Chronic sun exposure will in many produce a thickened layer in the upper dermis known as solar elastosis, which gives a yellowish chicken-skin look.

Some individuals will develop more blood vessels, known as telangiectasias or broken blood vessels. If damage is severe, thinning of the skin and bruising may be seen particularly on the hands and forearms.

Pre-Cancerous Changes of the skin
The most common indication of chronic sun exposure most often seen in fair-skinned individuals is actinic or solar keratosis. These are usually small, reddish or reddish brown, rough areas on the skin with a hard surface. Sometimes the smaller lesions can be felt more easily than they can be seen. As they progress they often develop a thick, rough whitish scale. This is seen most commonly on the face, ears, bald scalp, and on the backs of the hands. The lower legs of women are also risk areas.

Skin Cancer
Basal cell carcinomas are the most common of skin cancers, which again are associated with chronic sun exposure. They are also more common at sites of burns, scars and those with a history o of arsenic ingestion. These are most often raised, skin-coloured bumps (papules). These may have a pearly appearance. They sometimes have telangiectasias (small blood vessels) over them. There is often a history of easy bleeding from the area. On the trunk or limbs basal cell cancers can look like persistent well-defined, reddish, slightly scaly patches resembling psoriasis. They usually remain unchanged for many years if untreated and slowly grow. Other basal cell carcinomas can be slightly pigmented and the least common is the appearance of a scar-like lesion that appears on the face without history of trauma. These are known as a morphea or fibrotic basal cell carcinoma.
Most basal cell cancers occur on the face and neck. They are uncommon one the back of the hands, forearms, palms, soles and scalp.
There are three rare genetic disorders that are associated with BCC.

Squamous cell carcinoma is second most common type of skin cancer. There is an increased risk of squamous cell carcinoma developing from actinic keratosis (described above). This type of skin cancer can be aggressive at times, particularly those arising from the lips (actinic chielitis).
These usually arise from skin that is clearly sun-damaged. Squamous cell cancers are most often red and scaly lesions. Occasionally these can present as ulcers or raised warty growths. They normally have a depth or thickness to them, which means that the surface or epidermis grows thicker and downwards into the dermis. There is often a low-grade inflammation that is the reaction from the immune system.
It is rare to see these cancers arising from normal looking skin. Sundamage is clearly the biggest risk although scars, physical burns and stasis ulcers, which are chronic, are also a risk.

Malignant melanoma is the most threatening skin cancer. Most of the time, these cancers appear intensely pigmented. Dark brown or black lesions should be looked upon with suspicion and should be checked by a physician. The bigger lesions are more suspicious (over 6mm) but these cancers are best detected when they are very small. The best clue is the intense, dark pigmentation. Irregular pigmentation within the lesion as well as irregular boarders is also of concern. Early detection and treatment of a melanoma is important as melanomas can be fast growing. About one half of them arise from moles while the other half will develop from normal looking skin.