Actinic Keratosis


What is an Actinic Keratosis?

An actinic keratosis is a collection of damaged cells (called keratinocytes) which reside within the top layer of skin (epidermis). Usually caused by the sun’s harmful ultraviolet radiation, actinic keratoses are often used as an indicator of chronic sun damage. Because a small proportion of these lesions may transform into a skin cancer known as squamous cell carcinoma, actinic keratoses are frequently referred to as “precancers”. It is currently estimated that approximately 10% of untreated actinic keratoses may evolve into squamous cell carcinoma. Individuals most at risk for development of actinic keratosis have a history of excessive ultraviolet or tanning bed exposure, light hair, fair eyes, family history of skin cancer or a depressed immune system.

What does an actinic keratosis look like?

Actinic keratoses are scaly or crusty lesions that vary in size and thickness. While many are flesh-colored, others may be brown or red. The earliest actinic keratoses may be difficult to see and are best appreciated as a “sandpaper” or rough texture on sun-damaged skin. While some people will have only one or a few actinic keratoses, many patients will have dozens. When an actinic keratosis develops on the lip, it is referred to as actinic chelitis.

How is an actinic keratosis diagnosed?

During a skin examination, your dermatologist will identify and potentially treat any suspicious lesions. In other circumstances, your dermatologist may choose to biopsy an abnormal lesion to exclude skin cancer. After the biopsy is performed, the skin sample is sent to a laboratory and processed before very thin slices are cut and placed onto a glass slide. Your dermatopathologists will look at the slide under a microscope and make a diagnosis. This result is presented to your doctor in a final dermatopathology report.

What are the treatment options for actinic keratosis?

Multiple modalities are available for the treatment of actinic keratoses, and your physician will consider your general health in addition to the size, number and location of your lesions before choosing the best method for you. Options include liquid nitrogen cryotherapy (a “freezing spray”), topical creams, photodynamic therapy, chemical peels, laser treatments or any combination of the aforementioned.

What can I expect after a diagnosis of actinic keratosis?

Once an actinic keratosis has been diagnosed, it is important to know that you will likely develop more. You are also at risk for formation of other skin cancers, especially squamous cell carcinoma. It is essential to have regular skin cancer examinations, so that actinic keratoses or other suspicious areas may be promptly diagnosed and treated. Any lesion that grows, bleeds, becomes tender, itches or fails to respond to treatment should be immediately brought to the attention of your dermatologist.

How can I protect myself from skin cancer or more actinic keratoses?

The use of an appropriate broad-spectrum sunscreen, protective clothing and broad-brimmed hats are critical to prevent further damage caused by the sun’s ultraviolet rays. When planning outdoor activities, attempt to avoid peak hours of ultraviolet exposure, which typically occur from 10 a.m. until 3 p.m. Choose a sunscreen with a sun protection factor (SPF) greater than 30, and reapply every two hours and after each water exposure. Seek the shade and be conscious of ultraviolet reflections from water and snow. Do not use indoor tanning facilities. Be sure to perform monthly self skin examinations and immediately report any suspicious lesions to your dermatologist.

Where can I get other information about actinic keratosis?

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