Actinic Keratosis

Actinic keratoses (AKs) are dry, scaly patches on the skin that are a result of sun exposure and are considered precancerous. They form on sun-exposed areas of the body, including the scalp, face, forearms, and back of the hands. AKs feel like sandpaper to the touch and can occasionally itch or become tender. Actinic keratoses range in color from skin-toned to reddish brown. They can be as small as the head of a pin or as large as a quarter (or bigger, if left untreated). 

Most people with one AK lesion will develop others. When these occur on the lip, they are referred to as actinic cheilitis and typically present as cracked, dry lips, often around the border of the lip.

In relation to Skin Cancer – Actinic keratoses are considered PRECANCEROUS because they have the potential to become a type of skin cancer called squamous cell carcinoma (SCC). In fact, up to 40-60% of SCC’s are believed to originate from untreated pre-cancer lesions. Additionally, since AKs result from chronic sun exposure, those with AKs are also at risk for developing other skin cancers, such as basal cell carcinoma or even melanoma. Therefore, diligent detection and intervention is essential.

Fortunately, actinic keratoses are treatable when detected in the early stages. People at risk for actinic keratoses and skin cancer can reduce that risk by performing frequent skin self-exams and seeing their doctor for regular screenings.

Risk Factors

  • Excessive sun exposure
  • Living in sunny climates
  • Light-colored skin/hair
  • Age >40
  • Weakened immune system due to underlying illness or immunosuppressive medications

Treatment Options

  • Cryosurgery* – “freezing” the lesions with liquid nitrogen, causing the lesions to blister within 24-hours, scab over, and eventually fall off; the fastest. *This is the most common method of treatment.
  • Topical medication (e.g. 5-FU) – destroys sun-damaged skin over several days by irritating the lesions and upon completion of the treatment, new skin replaces the precancerous lesions
  • Chemical peel – acid is applied to the skin by your provider in the office; the skin becomes very red and peels over the next 10-14 days, leaving new skin in the place of sun-damaged skin

Other Tips

  • Avoid sun exposure and indoor tanning. When outdoors, make sun protection a priority (SPF >30, UPF clothing, wide-brimmed hat). 
  • Be patient with treatment – some AK treatments take longer than others and some lesions require more than one treatment
  • Treatments usually make the lesions appear worse before they get better
  • Perform regular skin self-exams and see your dermatologist at least yearly