Actinic Keratoses

More than 10 million Americans have actinic keratoses (AKs). AKs have the potential to progress into squamous cell carcinoma (SCC), the second most common skin cancer. While most AKs remain benign, approximately 10 percent develop into SCC within an average of two years. Since there is no way to know ahead of time which ones will become cancerous, it is very important to seek the care of a skilled skin specialist. Frequent skin examinations are the key to early detection and prevention.

What are Actinic Keratoses (AKs)?

AKs – often called “sun spots”— are rough-textured, dry, scaly patches on the skin caused by excessive exposure to ultraviolet light (UV) such as sunlight. They occur most often on the face, scalp, ears, neck, hands and arms and can range in color from skin toned to reddish brown. They can be as small as a pinhead or larger than a quarter.

What do AKs look like?

Actinic Keratoses generally begin as rough spots of skin that may be easier felt than seen. Common complaints include a lesion that has increased in size or one that is raised, bleeding, poor in healing, discolored, or associated with discomfort such as pain or itching.

While a lesion may initially appear skin colored to pink, red, or brown, lesions on darker skin may be more pigmented. AKs may feel soft, rough, or “gritty.” In any case, they feel different from the surrounding healthy skin. Actinic keratoses can appear in groups and may be undetected. Occasionally they may itch or become tender, especially after direct sun exposure.

When actinic keratoses occur on the lip they are referred to as actinic cheilitis. This type of AK appears as cracking, dried lips often around the border of the lip.

Since there are many clinical variants of AKs, it is best to consult a dermatologist if you suspect a lesion.

Who gets AKs?

AKs are seen primarily in Caucasians with pale skin living in sunny climates. Areas of the skin with the most sun exposure, such as the head, neck, forearms, and hands account for more than 80% of AKs.

Actinic Keratoses develop as the result of years of sun exposure. Because the effect of sun exposure is cumulative, it is your lifetime exposure that increases your risk. Even if you didn’t suntan much, years of just doing simple tasks outside can add up to significant amount of sun exposures. For example:

  • Going out to the mailbox
  • Playing an outdoor sport
  • Walking the dog

Because AKs take a long time to develop, they generally appear after the age of 40. The American Academy of Dermatology estimates that 60 percent of people most likely to get Actinic Keratoses will indeed get at least one AK in their lifetime. People with weakened immune systems due to underlying illness or the use of immunosuppressive medications (such as chemotherapy) are also much more likely to develop AKs.

Your risk of developing AKs increases if you have one or more of the risk factors such as:

  • A history of cumulative sun exposure
  • Fair skin
  • Blond or red hair, in particular if combined with blue, hazel or green eyes
  • A tendency to freckle or burn after sun exposure
  • A weakened immune system

Actinic keratoses are considered precancerous by many physicians and dermatologists. On average, 40%-60% of squamous cell skin cancers begin as untreated AKs. At Skin PC, we are diligent in diagnosing, treating, and monitoring all stages of AKs. Actinic keratoses are treatable when detected in their early stages. Performing frequent skin self-exams and regular screenings at a dermatologist can help with early detection.


There are many actinic keratosis treatment options. To determine the best course of treatment, the doctor will consider several factors including age, medical history, severity of the lesions, and your own personal preferences. There are several safe and effective topical medications including:

  • 5-fluorouracil or “5-FU” (Carac® or Efudex®)
  • Picato® Gel (ingenol mebutate)
  • Solaraze® (diclofenac sodium – 3%)
  • Zyclara™ (imiquimod) Cream, 3.75%

Several dermatologic procedures are also effective for actinic keratosis treatment. Your doctor will recommend a procedure that is best suited to the location of the actinic keratoses and other variables. These procedures may be combined with other actinic keratosis treatments or medications.

  • Cryosurgery uses liquid nitrogen to freeze off the lesions. It is fast, has a high cure rate, and is well-tolerated by most people. There may be a very brief period of stinging when the liquid nitrogen is first applied, but anesthesia is not required.
  • Shave removal is a procedure during which a scalpel is used to remove the lesion and obtain a specimen for testing.
  • Curettage is often used to remove hard, thickened actinic keratoses. In this procedure, a small, round, sharp instrument (called a curette) is used to scrape the actinic keratosis, either removing a piece of it for biopsy or removing the entire lesion.
  • Lasers deliver an intense light focused on the lesion, removing it along with the top layer of skin. The finely controlled nature of laser removal makes this a useful option for actinic keratoses on delicate skin, such as the lips (actinic chelitis), or in narrow, hard-to-reach places (such as behind the ears).
  • Photodynamic therapy uses a substance that is applied to the skin that makes the AK lesions very sensitive to light. A laser or light is then directed onto the skin that destroys the lesions.

Ask an experienced skin specialist to learn more about these procedures and treatment. At Skin PC, we will work with you and your individual needs to determine which course of action is right one for you. Whether your treatment is an in-office procedure that takes just an hour or a topical regimen that lasts several weeks, your doctor will monitor your skin’s condition to make sure the treatment is working and that side effects are manageable.