Actinic Keratosis

What are actinic keratoses?

Actinic keratoses (solar keratoses) are rough, scaly patches that result from years of sun damage. They are very common and are considered a pre-cancerous condition because, if left for many years, a very small proportion can develop into squamous cell carcinoma.

Who gets them?

They are very common in older people, and in some parts of the UK up to 1 in 4 people over 60 have them. People with fair skin that burns instead of tanning, blue eyes, and red or blonde hair are most prone, especially after years of heavy sun exposure through outdoor work, sunbathing, sunbeds or living somewhere sunny. People with a weakened immune system, especially organ transplant recipients, and people with rare conditions such as albinism are at higher risk.

What causes them?

Actinic keratoses are caused by cumulative ultraviolet (UV) damage to skin cells over many years, from the sun or sunbeds. They signal sun-damaged skin and a raised risk of all three main skin cancers: BCC, SCC and melanoma.

Are they hereditary or contagious?

They are not inherited, although the fair skin type that makes them more likely runs in families. They are not contagious.

What do they look and feel like?

Actinic keratoses appear on areas that have had the most sun, especially the scalp in people with thinning hair, the forehead, face, nose, ears, lips, backs of the hands and forearms. They are often easier to feel than to see, with a rough, dry texture like sandpaper. Their colour varies from skin-toned to pink, red or light brown, and their size from a few millimetres to over a centimetre. Some develop a thick, hard surface or a horn-like projection. They can be tender, itchy or catch on clothing or a hairbrush.

Often there are many actinic keratoses across an area of sun-damaged skin, which is described as field change. The surrounding skin often shows other signs of sun damage, such as blotchy colour, freckling and wrinkling. On the lower lip, a similar process called actinic cheilitis causes persistent dryness, scaling and blurring of the lip margin.

How are they diagnosed?

Actinic keratoses are usually diagnosed from their appearance and feel, often with the help of a dermatoscope. A biopsy may be recommended if a patch is thick, painful, growing quickly, bleeding, or does not behave like a typical actinic keratosis, as these can be signs that it has become a squamous cell carcinoma.

What are the treatment options?

Dr Mounsey will examine the affected skin and check for any lesion that could be a skin cancer, which may need a biopsy. Treatment options include creams such as 5-fluorouracil, imiquimod or diclofenac gel, which treat both visible patches and the surrounding sun-damaged skin. Individual lesions can be treated with cryotherapy, which he performs himself, or with curettage. Photodynamic therapy may be recommended for larger areas. He will also advise on sun protection and regular skin checks.

What is the outlook?

Most actinic keratoses do not become cancerous, and some disappear on their own, but they tend to recur and new ones commonly appear, because they reflect underlying sun damage. A very small proportion progress to squamous cell carcinoma, although people with more than ten actinic keratoses have around a 10 to 15 in 100 chance of developing one, so any patch that thickens, grows, becomes painful or bleeds should be checked promptly. Sun protection is important to reduce further damage.

More information

British Association of Dermatologists patient leaflet: https://www.bad.org.uk/pils/actinic-keratoses

If you have any questions about your procedure, please contact the clinic before booking.

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.