Actinic Keratosis

What is an actinic keratosis?

An actinic keratosis (AK) is a precancerous lesion characterized by rough or scaly skin that commonly appears in areas frequently exposed to the sun. Although a small percentage of these lesions may progress to squamous cell carcinoma if left untreated, most do not become cancerous.

AKs are common, especially in fair-skinned patients and in those with significant cumulative sun exposure over time.

What causes actinic keratoses?

Actinic keratoses develop from chronic ultraviolet damage to the skin including sunburns. Over time, repeated sun exposure causes abnormal skin-cell growth, which can lead to these rough spots.

Because they reflect cumulative sun damage, patients with AKs often have more than one lesion and may develop new ones over time.

Additional risk factors include fair skin, a compromised immune system, certain genetic disorders, and infection with human papillomavirus (HPV). Commonly affected areas include the face, scalp, arms, and hands.

What are the symptoms of actinic keratoses?

Symptoms can include:

• Rough or sandpaper-like spots on the skin

• Pink, red, tan, or skin-colored scaly patches

• Lesions that are easier to feel than to see

• Tenderness, burning, or itching in some spots

Some AKs stay stable, but others can thicken or become more concerning over time.

How are actinic keratoses treated?

Multiple treatment options are available for actinic keratoses:

• Cryotherapy: Application of liquid nitrogen to freeze the lesion

• Topical Chemotherapy Creams: Such as 5-fluorouracil (5-FU) or imiquimod

• Photodynamic Therapy: Involves the application of a topical photosensitizing agent followed by exposure to specific wavelengths of light

• Tirbanibulin (Klisyri) as another topical field-treatment option for appropriate patients

Because AKs are precancerous lesions, regular follow-up is often important, especially in patients with many lesions or a history of skin cancer.

How do I prevent actinic keratoses?

Helpful strategies can include:

• Regular sunscreen use

• Sun-protective clothing and hats

• Avoiding tanning beds

• Routine skin exams when recommended

• Reporting any lesion that becomes tender, thick, rapidly growing, bleeding, or non-healing