actinic keratosis pictures on backactinic keratosis pictures on back
Your face may be a bit red and sore for a few weeks after this treatment. Along with the causes of dark, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Because of this, the lesions are often calledprecancer. However, you should have your spots examined by a doctor promptly if you notice any of the following changes: Dont panic if there are cancerous changes. If you have one or more AKs, your dermatologist will talk with you about whether to treat these precancerous skin growths. Its also a good idea to consider visiting a dermatologist at least once a year to monitor your skin health and any new spots or moles. Causes of actinic keratosis. The cancer is capable of spreading to other regions of the skin. When found early and treated, skin cancer is highly treatable. After the completion of treatment, patients must avoid exposure to sun or fluorescent light for two days to prevent complications. This will help check for new actinic keratoses and skin cancer. your skin. Avoid going outside at midday, when the sun is brightest. As you perform your monthly self-exam, familiarize yourself with the moles, freckles, and other marks on your body, and look for any changes in them from month to month, including shape, size, color, or other changes, such as bleeding or itching. Here's why they develop, what to look out for, and how they're treated. Some manufacturers make specialty clothing with a high sun protection factor (SPF) rating, or you can purchase a special ingredient to be added to your washer that can wash SPF into your clothing. LK occurs almost always as a solitary skin growth; however, two or three lesions can occasionally be present. If you catch skin cancer early, you have a greater chance of success with treatment. As the area heals, you will see new healthy skin. . The lesion will scab over and fall off within a few days after the procedure. Mayo Clinic Staff. But sometimes an actinic keratosis can be hard to tell apart from skin cancer. The skin changes begin as flat and scaly areas. Actinic keratoses that develop on the lip are called actinic cheilitis. In some cases, a hard, wartlike surface. Your body can heal some of the damage from the suns rays, but the effects of radiation accumulate with every exposure. (2021). The treatment procedure is, however, discomforting and the skin may remain in the inflamed state for many weeks. Photodynamic therapy: This may be recommended for a patient who continues to get new AKs or has AKs that return after treatment. Types of surgery include: If you have multiple lesions on your face, your doctor may prescribe a topical cream or gel you can apply at home. This image displays actinic keratoses that have developed very thick, crusty scale known as hypertrophic actinic keratoses. Actinic keratosis develops over a number of years. A purpuric rash is made up of small, discolored spots under your skin from leaking blood vessels. Sometimes it looks like small bubbles or cysts within the growth. Nov. 25, 2020. Some of these are: The method involves application of extreme cold in the form of liquid nitrogen,solid carbon dioxide, or argon to destroy the abnormal lesions. This is actually one of the most common conditions that dermatologists diagnose and treat, so these doctors have a lot of experience with AKs. Sometimes, it takes on a red color. 2005-2023 Healthline Media a Red Ventures Company. It should block both ultraviolet A (UVA) and ultraviolet B (UVB) light. Spots usually appear in those who are older (over 50), but they can start appearing in younger adults who have had a lot of sun exposure. An actinic keratosis typically shows up on the face or other parts of the body that get exposed to the sun. It can smooth out deep wrinkles and lines, but the results arent permanent. Actinic keratoses usually develop in areas thatve been damaged by years of sun exposure. In rare cases they may come back. But there's a small chance they could become skin cancer, so it's important to avoid further damage to your skin. When did you first notice the patches or spots? Heres what you can expect when you see a board-certified dermatologist about AKs. In severely chronically sun-damaged individuals, they may also be found on the upper trunk, upper and . This treatment freezes the lesion. Symptom checkers like Aysa can help narrow down possible skin conditions by analyzing a skin photo. A variety of treatment approaches are available for remission of lesions. He has been writing for Prime Health Channel more than 750 high quality and informative based medical / health articles for both consumer and professional readers. Read on to know all about this disorder, including its causes, symptoms, diagnosis and treatment. the tops and undersides of your arms and hands. Rarely, it can spread to the dorsa of the . It works by removing the surface layer of the skin. What are the clinical features of actinic keratosis? Use a full-length mirror with the added assistance of a hand mirror, when necessary. They have a rough, scaly texture. There is a 7.5% to 10% risk of malignant transformation to squamous cell . The larger skin bumps are, however, more distinct and easier to identify. Actinic keratosis usually appears as a patch of dry, scaly skin. Sun exposure can cause rough lesions on your skin. Actinic keratosis: How to differentiate the good from the bad ones? Our website services, content, and products are for informational purposes only. Browse 30 actinic keratosis stock photos and images available, or search for basal cell carcinoma or melanoma to find more great stock photos and pictures. Padilla RS. Histopathological analysis of solar-damaged skin reveals UV-induced mutations in some genes, including TP53 as well as deletion of the gene encoding p16 tumor suppressor protein that regulate the cell cycle. skincancer.org/skin-cancer-information/actinic-keratosis/, aad.org/public/diseases/skin-cancer/actinic-keratosis-overview, medicaljournalssweden.se/actadv/article/view/1946, jamanetwork.com/journals/jamadermatology/article-abstract/2782523, jaad.org/article/S0190-9622(19)33290-6/fulltext, 5 Prescription Treatments for Removing Actinic Keratosis at Home, Everything You Need to Know About Nonmelanoma Skin Cancer, Mohs Surgery for Basal Cell Carcinoma: Before and After Treatment. Actinic keratoses are common, especially in older people, many of . Feel tender or painful when touched. Fitzpatricks Dermatology in General Medicine. The 2020 study mentioned listed how frequently AKs appear on each area of the face: Meanwhile, facial acne will most often erupt in your T-zone, which includes your chin, nose, and forehead. They have a rough, scaly texture. This causes the textural details that often distinguish the growths. Cover up with tightly woven clothing. Micali G, Lacarrubba F, et al. Here's how to tell them apart. Find her on Twitter and LinkedIn. This natural product is known to cure different types of skin ailments. Find out why dark spots appear and what can fade them. Some AKs look and feel inflamed. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Actinic keratosis (AK) is the most common precancer that forms on skin damaged by chronic exposure to ultraviolet (UV) rays from the sun and/or indoor tanning. You have a higher risk of developing this condition if you: are over age 60. have light-colored skin and blue eyes. Kang S, et al., eds. Ceilley RI, Jorizzo JL. It is best to perform the exam in a well-lit area after a shower or bath. Prevention is very important. The lower lip undergoes scaling and becomes rough, with blurring of the line bordering the lip and skin. Other areas include: The condition initially manifests as small crusty spotsmeasuring between 2-6 millimeters in diameter that cannot be easily spotted. This cream is laden with a non-steroidal anti-inflammatory drug, analogous to ibuprofen. These patches or plaques often form in clusters. Many methods are used to remove actinic keratosis, including: You're likely to start by seeing your primary care provider. Thisparticular version of keratosis is characterized by circumscribed, firm, scaling plaques with rich supply of inflammatory cells beneath the skin. When theyre left untreated, up to 10 percent of actinic keratoses can progress to SCC. This is medicine applied to the skin. Seborrheic keratosis vs. actinic keratosis. The Skin Cancer Foundation recommends that you: Stephanie Thurrott is a writer who covers mental health, personal growth, wellness, family, food and personal finance, and dabbles in just about any other topic that grabs her attention. Your doctor may recommend one or a combination, depending on factors like: Your doctor may recommend surgical treatment if you have only one or two isolated lesions. Actinic keratoses are considered precancers, and over time, actinic keratoses may turn into a type of skin cancer called squamous cell carcinoma. These are precancerous skin cancers that look like scaly patches on your skin, and they can turn into cancer in the future. These lesions are considered precancerous. Epithelial precancerous lesions. The condition is more obvious when simple blemishes on the skin transform into painful lesions, having high potential for malignancy. If you have several actinic keratoses, your health care provider might prescribe a medicated cream or gel to remove them, such as fluorouracil (Carac, Efudex others), imiquimod (Aldara, Zyclara) or diclofenac. When it heals in 1 or 2 weeks, you see new, healthier skin. In such cases, doctors can slightly stroke, scratch or rub the affected area of the skin to palpate these localized lesions. Following are the specialized forms ofSolar keratosis: In this type, the outermost layer of the epidermis consisting of dead cells, becomes hypertrophic and has a rough texture. McGraw Hill Medical, New York, 2008: 1007-15. Gavish has begun his career as a health and medical writer for daily newspapers. The photosensitizing medication gets activated and releases an oxygen molecule, which directly destroy the lesions. See pictures and learn about causes, prevention, diagnosis, treatment, and, A new mRNA skin cancer vaccine being developed by Moderna showed promise in a phase 2 clinical trial in treating late-stage melanoma, The glycemic index (GI) is a value used to measure how much a specific food increases your blood sugar levels. RM 2JC4JD2 - Man, 71, patient, head, bald, face, with light damage, actinic keratosis, six days after photodynamic therapy (PDT), laser treatment, lasered, Ameluz. 2016; doi:10.1001/jama.2016.3065. Use sunscreen on all exposed skin areas, including the lips, before going outdoors. Risk Factors for Actinic Keratosis. Heres a quick guide to help you identify a spot on your face. The image depicts actinic keratosis, which is the most common precursor of cutaneous invasive squamous cell carcinoma. With your elbows bent, examine the front and back of your arms as well as your elbows, hands, fingers, area between your fingers, and fingernails. Actinic keratosis can resemble other skin issues like age spots and acne. The following are some of the natural treatments you can try for actinic keratosis: 1. Actinic keratoses localized superficial tumors with the biological potential to develop into invasive skin cancer.Although the chance of an individual actinic keratosis progressing into an invasive squamous cell carcinoma is less than 1%, patients with many of these lesions (very common) who continue to expose their skin to carcinogenic ultraviolet sunlight are likely to develop invasive skin . The best way to prevent AK is to reduce your exposure to sunlight. Actinic keratoses are often painless, and you usually wont notice them unless youre looking in a mirror. According to the AAD, a dermatologist can treat actinic keratosis with: Or, your dermatologist can prescribe a medication that you apply to your skin at home. They may want to take a skin biopsy of any lesions that look suspicious. If you want to diminish a noticeable scar, know these 10 things before having laser treatment. The scale or crustmay behorny, dry, and rough. The downside of applying medication to your skin is that some patients say its difficult to follow the treatment plan. The growths may be gray, pink, red, or the same color as your skin. New York: Mosby, 2003. Your health care provider will likely be able to determine whether you have an actinic keratosis simply by looking at your skin. (2020). Your dermatologist will explain how to protect your skin so that you can get home. Arsenical keratosis is a precancerous dermatosis seen in patients with chronic arsenic toxicity (CAT). These can include the face, ears, bald scalp, neck, backs of hands and forearms, and lips. The light activates the solution, which can destroy the AKs. Last medically reviewed on December 5, 2022. A baseball hat does not give much protection. If you have a weakened immune system or a rare condition that greatly increases your risk of developing AKs and skin cancer, you may need to see your dermatologist every 8 to 12 weeks. Heres whats involved with each treatment. You can reduce your risk of actinic keratosis by avoiding indoor tanning and limiting your sun exposure. Many dermatologists recommend seeking treatment for each lesion you develop since theres no surefire way to predict which will become cancerous. Your risk increases if you live near the equator, work outdoors, or skip protection like sunscreen and hats. Sunscreen FAQs. While using this medication, you must protect your treated skin from the sun. 365, 719. Although the epidermis appears thick, there is a loss of granular layer with wide gaps between the cells. You may need to apply it for 12 to 16 weeks. Due to this risk, the spots should be regularly monitored by your doctor or dermatologist. Wear a hat with a brim of at . Actinic keratosis is a disorder of epidermal keratinocytes that is induced by ultraviolet (UV) light exposure ().These growths are more common in fair-skinned people and those who are frequently in the sun. Martin G, Swanson N. Clinical findings using ingenol mebutate gel to treat actinic keratoses. J Am Acad Dermatol 2013;68:S39-48. After cryosurgery, you may see crusting or a blister on your treated skin. In other cases, they come and go in the same spot. Your health care provider applies the substance to the affected skin, which causes blistering or peeling. In fact, Beta-papillomavirus has been discovered in patients with skin oncogenesis and UV-induced keratosis. Actinic keratoses are considered precancers . First lady Jill Biden is undergoing Mohs surgery to remove a skin lesion above her eye. Your dermatologist can tell you the best way to protect your skin. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Bloomberg-Kimmel Institute for Cancer Immunotherapy, Squamous Cell Skin Cancer of the Head and Neck. All rights reserved. These spots take the form of rough bumps with a scaly or flaky texture. They come in many colors: red, pink, gray, or a slightly darker shade of your skin color. This image displays multiple actinic keratoses on the face. Your time with your health care provider is limited, so preparing a list of questions will help you make the most of your appointment. Actinic keratosis: Overview. . Plaques don't move and are usually flat or only slightly raised. When you see a board-certified dermatologist about AKs, your dermatologist will: Ask questions about your health, medications, and symptoms. 18 common and not so common bumps, rashes and growths, A discoloration that looks like an age spot, A change in color where the lips start to match the color of the face, Have a weakened immune system or certain health conditions, such as, How many you have, where they are and what they look like. A few basic tips to prevent actinic keratosis include: Even if you already have a few spots, preventing future actinic keratoses can still lower your cancer risk. Sometimes a biopsy may be done to look for skin cancer. They often have a white or yellow crusty scale on top. With photodynamic therapy, your dermatologist will spread a chemical agent across the actinic keratoses on your face. Color variations, including pink, red or brown. It is also called squamous cell skin cancer in situ or Stage 0 . Sometimes people will say, I just have this dry skin that wont get better, Ferris said. These dermatologists' tips tell you how to protect your skin. The lesson learned here is just because a freezing chemical spray can cause a skin lesion to fall off, doesn't mean that there should necessarily be any dramatic changes in appearance (as there often is with actinic keratoses). With a chemical peel, your dermatologist will apply a caustic chemical to your skin to peel back the outer skin layer. We are vaccinating all eligible patients. In some cases, it fades and reappears over a long period of time. Skin cancer is the most common cancer in the United States. A dermatologist is a medical doctor who specializes in treating the skin, hair, and nails. An actinic keratosis (also known as a solar keratosis) is the most common skin condition caused by sun damage. According to the AAD, youre at higher risk for actinic keratoses if you: "People with darker skin types tend to have fewer actinic keratoses than those with lighter skin tones because they have more natural protection from the sun," said Arthur. Image Source: 2007 Interactive Medical Media LLC. Micali G, Lacarrubba F, et al. Actinic keratosis is often referred to as a pre-cancer, and when left untreated, these skin lesions can develop into skin cancer. Some people are more at risk than others, including: People with pale skin, blonde or red hair, and blue, green, or gray eyes, People with darker skin, hair, and eyes who have been exposed to UV rays without protection, People with suppressed immune systems (due to chemotherapy, AIDS, organ transplant, or other causes), People with rare conditions that make the skin very sensitive to UV rays, such as albinism or xeroderma pigmentosum (XP). Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. What will the treatments cost? AKs are often more easily felt than seen. The skin becomes tender when multiple lesions develop within a single area, causing more discomfort and agony. 6th ed, pp. Sunburn. Youll find the self-care that dermatologists recommend at, Actinic keratosis: Self-care. Use a hat with a wide brim. Duncan KO, Geisse JK, et al. Actinic keratosis is a common skin condition that frequently appears on the face. If there's any doubt, your health care provider may do other tests, such as a skin biopsy. Actinic keratosis. You can expect permanent results in all but one area. The material on this site is for informational purposes only, and is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. To be effective, treatment must destroy the AKs. Related searches: actinic keratosis. If you dont already have a dermatologist, you can browse doctors in your area through the Healthline FindCare tool. Have a look at some of the pictures of Actinic Keratosis for a better understanding. Curettage: If you have an extremely thick AK, this may the best treatment. During the first part of treatment, a solution that makes your skin extremely sensitive to light is applied to the area with AKs. Marques E, et al. In . These scaly patches are pre-cancerous and can develop into skin cancer if left untreated. Preventing these lesions becomes especially important if you have risk factors like pale skin or immunodeficiency. Answer C is an essential feature of actinic keratosis as it has well established its link in the development of squamous cell carcinoma either in the classical or differentiated pathways. SCC is the second most common type of skin cancer. This is performed in order to inspect the current stage of precancerous keratosis and rule out the presence of cancer. Tirbanibulin ointment: This may be an option for treating AKs on your face and scalp. Gibson LE (expert opinion). Inspect the tops and bottoms of your feet, the area between your toes, and toenails. A biopsy can usually be done in a clinic after a numbing injection. Clinical Information and Differential Diagnosis of Actinic Keratosis (Solar Keratosis), Mild one or two spots, not thick or hard, Severe numerous or thick, hard, or bleeding spots. It most likely appears onareas of skin often exposed to the sun. If you have what feels like razor bumps or acne on the back of your neck or scalp, you may have acne keloidalis nuchae. Find out what may be causing the itch and what can bring relief. Guorgis G, et al. Should you have an AK, an accurate diagnosis and treatment can: Reduce your risk of developing skin cancer, Get rid of an AK, replacing it with new, healthy-looking skin, Help ease symptoms, such as itch, pain, or tenderness. Itching and burning in the affected regions are its additional features. As the epidermal cells begin to deteriorate, there is a modification in the texture and color of the skin. Individuals who are at an increased risk of developing the conditionmust strictly adhere to the following remedial measures: Actinic keratosis has a high rate of malignant transformationand must be immediately diagnosed if the skin spots undergo a sudden change. Sometimes, physicians prefer other means of surgical procedures to remove the painful lesions. A few basic tips to prevent actinic keratosis include: Buy quality sunscreen: Look for sunscreen with broad-spectrum UV protection and an SPF of 30 or higher. Actinic keratoses occur most frequently in fair-skinned people. Emily Swaim is a freelance health writer and editor who specializes in psychology. To prevent actinic keratosis, it's important to: Avoid exposure to sunlight during peak sunlight hours (10 a.m. to 2 p.m.). Find Seborrheic Keratosis stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. If you have many AKs or AKs that you can feel but not see, your dermatologist may recommend at-home treatment. When you treat at home, you apply medication to your skin as directed. A dermatologist or other doctor can help diagnose these spots and recommend the best treatment plan for your needs. All rights reserved. A prospective, longitudinal study found the risk of progression to be 0.24 percent per year for each actinic keratosis. Bleed. Overview. The sun constantly releases UV radiation, which, like most forms of radiation, isnt great for your skin. We see [actinic keratoses] more frequently on chronically sun-exposed areas like the face, forearms and the backs of the hands, said Dr. Laura Ferris. Image 1: J Am Acad Dermatol. To freeze the AK, your dermatologist will apply a very cold substance like liquid nitrogen to the AK. Burn or sting. Topical pharmacotherapy for skin cancer: part 2: Clinical applications, J Am Acad Dermatol 2014;70:979.e1-12. Find out what can help. Actinic keratosis treatment can reduce your risk of cancer and smooth out your facial complexion. Although people with light skin are more likely to have actinic keratosis, these spots can appear on people with any skin tone. Seborrheic keratoses are raised growths on the skin. People who have skin thats been badly damaged by ultraviolet (UV) light develop AKs and have a higher risk of getting skin cancer. Evaluation of long-term clearance rates of interventions for actinic keratosis: A systematic review and network meta-analysis. These herbal formulations also protect the skin from the damaging effects of UV rays. In pictures of actinic keratosis, you'll see they are typically pink, scaly, and flat. Some people develop a few AKs, which can often be cleared with treatment. Certain topical treatments such as 5-fluorouracil (Carac, Efudex, Fluoroplex, Tolak) cause inflammation and destruction of the lesions. It can be caused by conditions that range from mild, Learn all about dark circles under your eyes. Commercial tanning lamps as well as beds form the potential source for solar damage besides sunlight. You will need to apply it twice a day for 2 to 3 months. Keratosis On The Scalp. What suspicious changes in my skin should I look for? Keratosis exists in a variety of types that are categorized by different degrees of severity. The Food and Drug Administration (FDA) has approved the following medications: Other treatments that may help address widespread actinic keratosis include photodynamic therapy specifically, blue light therapy and chemical peels. Treatment for an actinic keratosis may include: Cryotherapy. Current issues in the management of actinic keratosis. J Am Acad Dermatol 2013;68:S28-38. Local destruction with freezing (cryosurgery), scraping (curettage), burning (electrocautery), dermabrasion, or a laser, Creams with either tretinoin, adapalene, fluorouracil, diclofenac, or imiquimod. 2022 WebMD, Inc. All rights reserved. Apple Cider Vinegar. These lesions most commonly appear on the:. This condition is related to squamous cell carcinoma of the skin and is often described as a precursor or early form of squamous . However, they can be felt by stroking the skin. Cutaneous horns are much more likely to become cancerous than other types of actinic keratosis, so if you have one of these on your face, a dermatologist should examine it right away. There are several, It's not just the ingredients. Some actinic keratoses can turn into squamous cell skin cancer, so it is important to perform self-examinations often and catch them early. This will also help minimize your risk of skin cancer. Actinic keratoses are very common, and many people have them. 2005-2023 Healthline Media a Red Ventures Company. These can include the face, ears, bald scalp, neck, backs of hands and forearms, and lips. Most patients with AKs need 2 PDT treatments, with the second treatment given 3 weeks after the first. AK is primarily caused by long-term exposure to sunlight. solar keratosis. Your doctor may choose to remove extra tissue around or under the lesion if there are concerns about skin cancer. Best sunscreens for every age and sensitivity level, American Osteopathic College of Dermatology, How to avoid squamous cell carcinoma this summer, Whats on my skin? Seborrheic keratoses are characterized by keratin on the surface the same fibrous protein that fingernails, hooves, and horns are made of. Freedberg, Irwin M., ed. They are believed to form when skin gets damaged by UV . (2022). Normally, it takes 2 days for the 0.05% gel to show positive results, whereas the 0.015% gel requires minimum 3 days for complete treatment of the condition. Actinic keratosis is often caused by sun damage and results in scaly or crusty skin growths. An actinic keratosis sometimes disappears on its own but might return after more sun exposure. In the course of time, the skin lesions grow bigger in size. During a skin biopsy, a small sample of skin is taken for analysis in a lab. Your skin has been severely damaged by UV light, so its likely youll continue get new AKs. This means that if you already have an AK, you are likely to develop . A single copy of these materials may be reprinted for noncommercial personal use only. With this condition, you develop scaly, discolored spots called actinic keratoses. This is called Bowen's disease, a very early squamous cell skin cancer that is only in the epidermis. The condition typically occurs on the scalp and back of the hands. Affected individuals can use gels containing 0.05% or 0.015% of the substance on trunk, upper extremities, face and scalp. Learn. However, real age spots are smooth, not scaly. The base of an actinic keratosis may be light or dark . Our website services, content, and products are for informational purposes only. (2017). This is a precancerous condition of the skin marked by asmall lesion due to increased exposure to UV rays from the sun. To effectively treat the AKs, your dermatologist may prescribe both a procedure and medication that you apply at home. Limiting time in the sun helps prevent the formation of actinic keratoses. Mohs surgery is a highly successful outpatient procedure used to treat and cure various forms of skin cancers, including basal cell carcinoma. SCC is relatively easy to diagnose and treat in its early stages. Compared to the general public, people with actinic keratoses were: While many actinic keratoses pose no medical risk, theyre worth paying attention to, just in case one turns cancerous. These cancers are treatable and have a better outlook than melanomas. Its also known as asolar keratosis. Wear hats and shirts with long sleeves when youre in bright sunlight. To be effective, you need to apply the medication as often as your dermatologist recommends. Later, they may become hard and wart-like or gritty and . Actinic keratosis is often found in areas of the body that receive the most sunlight, which includes the face, scalp , ears, shoulders, neck, and hands. What are my treatment options and the pros and cons of each? Actinic keratosis is also known as AK and solar keratosis. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Patches are usually less than an inch in size with slight scale (sometimes thick like a wart) and a pink, red, or brownish color. Actinic keratoses, also known as solar keratoses, are small rough or scaly areas of skin due to damage from sun exposure. Using one of these will prevent your AK treatment from working. They may be oval spots a fraction of an inch across, or form long Christmas tree like .