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Actinic Keratosis

What is actinic keratosis?

Actinic keratosis (AK) is a rough, scaly spot or bump on sun-exposed skin. Most people with AK have more than one spot.

AK is the most common precancer of the skin. Over time, it can develop into squamous cell skin cancer. Most squamous cell skin cancers started as AKs. Because of this, actinic keratoses (AKs) are often treated. If they’re found and treated early, they don’t have the chance to develop into skin cancer.

What causes actinic keratosis?

Ultraviolet (UV) rays from the sun and from tanning beds cause almost all AKs. Damage to the skin from UV rays builds up over time. This means that even short-term exposure to sun on a regular basis can build up over a lifetime and raise the risk for AKs.

Who is at risk for actinic keratosis?

A risk factor is anything that may increase your chance of having a disease. Some risk factors may not be in your control. But others may be things you can change.

You are more at risk for AKs if you:

  • Have pale skin, blonde or red hair, and eyes that are blue, green, or gray

  • Have skin that burns easily or gets freckles when you’re in the sun

  • Have been exposed to UV rays without protection

  • Are older than age 40

  • Live in a place that gets intense sunlight all year

  • Use tanning beds or sunlamps

  • Have a weakened immune system from chemotherapy, AIDS, or an organ transplant

  • Have a rare condition that makes your skin very sensitive to UV rays, such as albinism or xeroderma pigmentosum

  • Work outdoors or spend a lot of time in direct sunlight

What are the symptoms of actinic keratosis?

AKs develop slowly in the top layer of skin. They mostly start on skin that’s often exposed to and damaged by the sun. This includes the face, ears, bald scalp, neck, backs of hands and forearms, shoulders, and lips. AKs tend to be flat spots on the skin of the head and neck. But they appear as bumps on the arms and hands.

The base of an AK may be light, gray, or dark, tan, pink, red, or a combination of these. Or it may be the same color as the skin and a change you feel rather than see. The scale or crust may be horny, dry, and rough. In some cases, the spot may itch or have a prickly or sore feeling. Some may bleed.

Sometimes the spots come and go, often coming back after sun exposure. Often you will have more than one AK.

AKs that develop on the lip are called actinic cheilitis. They can cause the lips to crack and feel scaly, dry, and rough.

How is actinic keratosis diagnosed?

AKs are often diagnosed when a person sees a healthcare provider about a skin change they’ve noticed. The provider will look at and feel the changed skin. The provider will ask about your health history and do a physical exam. All your skin may be checked, too. 

You may be sent to a dermatologist. This is a healthcare provider with special training to treat skin problems. A special light, magnifying lens, or camera may be used to get a very close look at the changed skin or lump. 

A healthcare provider can often diagnose an AK by looking at and feeling the area on your skin. But sometimes AKs can be hard to tell apart from skin cancer. You may need a biopsy. This is when small pieces of tissue are taken from the spot. These samples can be removed with a small blade or scalpel and examined under a microscope by a pathologist to rule out cancer. 

How is actinic keratosis treated? 

Treatment for AK aims to remove or destroy the spot and limit scarring as much as possible. The type of treatment may depend on how many AKs you have, where they are on your body, how they look, and if you had skin cancer in the past. It may include:

  • Cryotherapy. This treatment freezes spots that can be seen on the skin. This is the treatment most often used.

  • Topical chemotherapy and other medicines. These medicines are put right onto the skin to destroy the affected cells.

  • Chemical peels. Strong chemicals are used to destroy the top layers of the skin where the spot started.

  • Laser surgery. Intense light is used to vaporize thin layers of the spot until it’s all removed. This can be used to remove spots from the face and scalp, and actinic cheilitis from the lips.

  • Curettage and electrodessication. The spot is scraped away and heat is used to kill any damaged cells that may remain and stop bleeding.

  • Photodynamic therapy. Special chemicals are put on the spot and absorbed by the damaged cells. A few hours later, light is used to turn on the chemical and kill the cells.

Most AKs can be treated and cured. But they may come back. And if you have one, you likely will develop others. It’s important to have regular skin exams after treatment. These exams will help spot new AKs and skin cancer.

What are possible complications of actinic keratosis?

After treatment, the skin will be red and sore. With time, it will heal and new healthy skin will appear.

Some of the treatments increase sun sensitivity. Talk with your healthcare provider about this and be very careful to protect your skin from the sun.

It’s important that AKs be checked by a healthcare provider and treated, because over time they may turn into squamous cell skin cancer.

What can I do to prevent actinic keratosis?

You can help prevent AK by taking these steps:

  • Apply broad-spectrum sunscreen with at least SPF 30 every day. Cover sun-exposed skin with clothing and a hat. Limit sun exposure during the hours of the day the sun is most intense (from 10 AM to 4 PM) and stay in shaded areas.

  • Don’t use tanning beds or sun lamps.

  • Do regular skin self-exams to check for changes on your skin. If you notice anything, talk with your healthcare provider right away.

Key points about actinic keratosis

  • Actinic keratosis is a rough, scaly spot or bump on sun-exposed skin.

  • They are caused by UV damage to the skin.

  • People are more at risk for AK if they have pale skin, blonde or red hair, or eyes that are blue, green, or gray.

  • A skin exam and sometimes a biopsy are needed to diagnose this skin problem.

  • AKs are often treated, because over time they might turn into skin cancer.

  • Treatments include creams, cryotherapy, and laser surgery.

  • Minimize sun exposure and protect exposed skin. Do regular skin self-exams to check for new AKs and other skin changes.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.

Online Medical Reviewer: Jessica Gotwals RN BSN MPH
Online Medical Reviewer: Susan K. Dempsey-Walls APRN
Online Medical Reviewer: Todd Gersten MD
Date Last Reviewed: 8/1/2023
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