Bruce P.Robinson, MD

Actinic or Solar Keratosis (Pre-Cancer)

An actinic keratosis, is a rough, scaly patch on the skin that develops from years of sun exposure. It's often found on the face, lips, ears, forearms, scalp, neck or back of the hands. These represent pre-cancerous growths that can become skin cancer if left untreated.

If you find a spot or growth on your skin that you think could be an actinic keratosis (AK), it’s time for a thorough skin exam. 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

Most people who have AKs (or think they may have an AK) see a dermatologist. This is actually one of the most common conditions that dermatologists diagnose and treat.

How do dermatologists diagnose actinic keratosis?

When you see a board-certified dermatologist about AKs, your dermatologist will:

  • Examine your skin carefully
  • Ask questions about your health, medications, and symptoms

If you have one or more AKs on your skin, a board-certified dermatologist can often diagnose you by looking carefully at your skin. While examining your skin, your dermatologist will also look for signs of skin cancer. People who have skin that’s been badly damaged by ultraviolet (UV) light develop AKs and have a higher risk of getting skin cancer.

If you have one or more AKs, your dermatologist will talk with you about whether to treat these precancerous skin growths. Usually, treatment is recommended.

For a few people, a dermatologist may recommend frequent skin exams rather than treatment. Skin exams are recommended for patients who are frail and may find it hard to tolerate treatment. To be effective, treatment must destroy the AKs. When this happens, your skin will feel raw. It may be red and swollen for a brief time.

How do dermatologists treat actinic keratosis?

The treatment that is right for you depends on several considerations, including:

  • How many AKs you have
  • Where the AK(s) appear on your body
  • What the AK(s) look like 
  • Whether you’ve had skin cancer
  • Your other medical conditions, such as living with a transplanted organ

If you have one or a few AKs, a procedure that your dermatologist can perform during an appointment may be the preferred treatment.

Procedures for treating actinic keratosis

You can often complete treatment in 1 or 2 office visits. The procedures that dermatologists use to treat AKs include:

  • Laser skin resurfacing: Fraxel® Dual Laser was recently approved by the FDA for the treatment of actinic keratosis. This laser can achieve a very dramatic change in the skin with a treatment for both the epidermis (top layer) and the dermis (middle layer) of your skin. This may also be a treatment option for actinic cheilitis, a precancerous growth on the lip. It works by removing the surface layer of the skin. Read more on the Fraxel® Dual Laser here.
  • Topical Creams and Gels: If you have several actinic keratoses, your health care provider might prescribe a medicated cream or gel to remove them, Approved medications include: 5-flurouracil ( (Carac®, Efudex®, Fluoroplex®). Creams can be messy and some require application up to twice daily for 4-6 weeks and may not be used in pregnancy.
  • Cryosurgery: During cryosurgery, (liquid nitrogen - a very cold liquid gas) is applied to the growth with a cotton swab or spray gun to "freeze" it. A blister may form under the growth (this is normal and to be expected) which dries into a scab-like crust. The Keratosis usually falls off within a few weeks. Some AKs need more than one cryosurgery treatment before they fall off.  Your dermatologist can do this during an office visit while you remain awake with little to no discomfort.
  • Chemical peel: This is a medical-grade chemical peel used to destroy the top layers of skin. You cannot get this type of chemical peel at a salon or from a kit sold for home use.
    After a medical-grade chemical peel, the treated skin will be red, swollen, and sore. As the area heals, you will see new healthy skin. Learn more here ...
  • Curettage: If you have an extremely thick AK, this may the best treatment. During this procedure, your dermatologist first scrapes the AK from your skin, using a technique called curettage. Your dermatologist may follow this with a electrodesiccation, which heats the treated area to destroy any remaining AK cells.
  • Photodynamic therapy: This may be recommended for a patient who continues to get new AKs or has AKs that return after treatment. This procedure is a bit time-consuming because it consists of 2 parts.
    During the first part of treatment, a solution that makes your skin extremely sensitive to light is applied to the area with AKs. You’ll sit in the office with this on your skin for about 60 to 90 minutes. Afterward, you’ll be treated with either a blue or red light.
    The light activates the solution, which can destroy the AKs. As the treated skin heals, you’ll see new, healthier skin.
    For 48 hours after treatment, you’ll need to avoid the outdoors during daylight. The UV light, even on a cloudy or snowy day, can cause a serious skin reaction. Your dermatologist will explain how to protect your skin so that you can get home.
    Most patients with AKs need 2 PDT treatments, with the second treatment given 3 weeks after the first. 

Outcome for a patient with actinic keratosis 

Some people develop a few AKs, which can often be cleared with treatment. 

If you have many AKs, it’s a good idea to be under a dermatologist’s care. Your skin has been severely damaged by UV light, so it’s likely you’ll continue get new AKs. You may also develop skin cancer. Your dermatologist can watch for signs of new AKs and skin cancer. When found early and treated, skin cancer is highly treatable. 

Your dermatologist will tell you how often to return for check-ups. Some people need a check-up once or twice a year. 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.

Keep every appointment. If skin cancer develops, the sooner it is found and treated, the better your outcome.

Self-care also plays a key role in your outcome. The right self-care can help to prevent new AKs and skin cancer. 

Actinic keratosis often form on the face
AKs tend to be dry, scaly, and pink or red patches on the skin.
Actinic keratosis
An actinic keratosis often appears as a reddish spot (as shown here) that develops on skin you seldom protected from the sun over the years.
Actinic keratosis can form on the lip
A white, rough-feeling patch on your lip could be an AK. When an AK forms on the lip, the lips often feel extremely dry and may crack easily. It’s especially important to see a dermatologist if you notice any of these changes to your lip.
Actinic keratosis usually develop on the face, hands, or bald scalp
While many AKs are red or pink, some appear as brown spots. This man has a brownish AK. It’s the spot you see on his nose.
An actinic keratosis can look like a horn
While any AK can turn into a skin cancer, horns are more likely to do so. If you have a horn-like growth on your skin, it’s definitely time to see a dermatologist.
Some actinic keratosis look like age spots
These brown patches, which could be mistaken for age spots, are AKs. Unlike age spots, AKs tend to feel rough.
Actinic keratosis are common on the backs of the hands. Arrows point to the AKs, which are the reddish pink spots.
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