Concerned or worried about that rough red patch on your nose or cheek?

Perhaps you also have some scaly reddish or pink patches on your forehead, maybe between your eyebrows or even beneath your eyebrows.

Do the rough, red areas on your nose or cheeks come and go?

Or do they persist?

Here’s a better question:

What are the chances that the rough, red patch on your cheek or nose could be skin cancer?

If you have rough red areas on your cheeks or nose, it’s smart to keep an eye on them.

This is because based on the generic description of “rough, reddish patch” or “dry, scaly pink or red area” on the nose or cheek, this can actually describe a type of skin cancer called squamous cell carcinoma.

Squamous cell carcinoma. Shutterstock/Dermatology11

But don’t panic – because this description can also very well fit a few benign skin conditions.

There are two benign skin conditions that classically present as rough and red patches:

Seborrheic dermatitis (top-most image)

Actinic keratosis

“Seborrheic dermatitis is a rash on the face that is pink with scale,” says Dr. Monica Halem, MD, a dermatologic surgeon who specializes in skin cancer surgery, laser and cosmetic surgery.

“This is usually present on the laugh lines, and between the eyebrows. It is usually present on both sides of the face.”

I have seborrheic dermatitis, and I can easily understand how the layman can mistake this as skin cancer.

After all, many descriptions of skin cancer are similar to that of seborrheic dermatitis:

“Rough, red patch on the nose or cheek.”

Or, “Rough, scaly dry red or pink patch on the skin.”

This is a generic description of how non-melanoma skin cancer can present, but it also fits the description of seborrheic dermatitis.

A more detailed description of seborrheic dermatitis is as follows:

Often accompanied by flaking, especially on the nose

May have a very subtle orange tinge to the “red” or pink color

May crust where the nose meets the top of the “laugh line” area

May itch and slightly sting.

Another hallmark sign of seborrheic dermatitis is that it comes and goes. It can appear virtually overnight.

Seborrheic dermatitis can never morph into skin cancer.  

Actinic keratosis can also be described, generically, as rough red or pink patches or areas on the skin, particularly the nose and cheeks. It’s also called solar keratosis or “sun damage.”

Actinic keratosis. Shutterstock/Dermatology11

Dr. Halem says, “Actinic keratosis is usually much redder with thinner scale, and is in sun-exposed areas: top of the nose, sides of the cheeks, and forehead.”

For all practical purposes, actinic keratosis will NOT go away once it develops, even though medical literature cites that in rare instances, it can spontaneously disappear.

Actinic keratosis is when the keratocyte cells of the epidermis morph from typical to atypical.

The result is the classic rough, reddish patches that you one day discover on your nose, cheek or other part of the face.

Sometimes, the actinic keratosis can’t really be seen, but it can be felt; it has a distinct roughness to the fingers, kind of like sandpaper.

Dermatologists typically make a visible diagnosis that includes feeling the rough, red patches of skin with their fingertips.

If you’ve been diagnosed with actinic keratosis, don’t be alarmed, because your dermatologist will give you the other name that this skin condition commonly goes by: precancerous lesion.

Hearing this will trip a lot of people up, because their next thought will be, “Oh God, I’m gonna get skin cancer!”

However, the reason actinic keratosis is called a precancerous lesion is because its atypical cells are more likely to ever become cancerous, than are the typical cells right next door to the rough, reddish patch. That’s all that precancerous means.

Precancerous lesion does NOT mean predestined to become cancer.

It simply identifies that an atypical cell, more than a typical cell, is more likely to ever become malignant.

If actinic keratosis is left untreated, there is a 5-10 percent chance that it will morph into squamous cell carcinoma.

Squamous cell carcinoma. Shutterstock/Dermatology11

“Nobody really knows the time span for an AK to turn into an SCC,” says Dr. Halem.

“It can take anywhere from 2-10 years. It really depends on how much sun exposure you have had.

“More importantly to know is that 2 percent of all AK’s will turn into an SCC and there is no way of knowing which ones will do this.”

SCC skin cancer can metastasize, and kills about 3,500 to 10,000 Americans yearly.

However, in order for actinic keratosis to turn into the skin cancer, it must be left untreated.

And, believe it or not, there are people who ignore those rough, red patches or lesions on their face, chalking them up to age, harmless sun damage, stress, or who knows what.

Another reason that an actinic keratosis can go untreated is that a person can easily not even know they have these very gradually developing, red, rough patches on their skin — the skin on the top of their bald head, for instance.

This is a common site for actinic keratosis: A man’s bald head gets a lot of sun.

Finally, with 46 million Americans with no medical insurance, it’s easy to see why a person would not go to a doctor to have painless, rough red patches on their face checked out.

Actinic keratosis is very easily treated (removed) with a gentle spraying of liquid nitrogen; or the application of prescription creams.

Actinic keratosis on the cheek after a daily application of the topical cream Efudex for two weeks. The drug causes an inflammatory response that reddens the lesion before causing it to fall off. ©Lorra Garrick

Get it treated and keep an eye on your skin for the development of any new rough, red patches, and you won’t have to worry about squamous cell carcinoma.

Dr. Halem, Founder and Medical Director of The New York Dermatologic Surgery Cosmetic Laser Center, has devoted a decade to clinical research, conducting trials that have advanced cosmetic and surgical dermatology.
Lorra Garrick has been covering medical, health and personal security topics for many years, having written thousands of feature articles for a variety of print magazines and websites. She is also a former ACE-certified personal trainer.  


Top image: Shutterstock/sruilk