Actinic keratosis on the back of the hand

These patches are precancerous changes in surface skin cells. They are treatable, but a clinician needs to distinguish them from squamous cell carcinoma and from benign scaly spots.

The backs of the hands receive ultraviolet exposure during routine activities and are easily missed when sunscreen is applied. Actinic keratosis there may feel gritty, catch on fabric, or show a dry scale over a pink, red, tan or skin-coloured base.

The surrounding hand may also show uneven pigment, thin texture or other signs of sun damage. A dermatologist checks the entire area because an obvious patch can sit within a wider field of altered cells.

Book a routine dermatology visit for a persistent scaly area and avoid cutting, filing or treating it with an over-the-counter wart remover. Those actions can inflame the skin and obscure features needed for diagnosis.

A single clear lesion may be frozen, while multiple lesions may be managed with a prescribed topical medicine or photodynamic therapy. Treatment choice also considers skin thickness, healing ability and how much of the hand is affected. Reapply broad-spectrum sunscreen after handwashing and use gloves for prolonged outdoor exposure when practical.

Request faster review for rapid enlargement, increasing thickness, tenderness, spontaneous bleeding, a persistent crust or an ulcer. Squamous cell carcinoma can present with these changes, although examination and sometimes biopsy are needed to determine the cause.

Redness spreading from a treated site, worsening swelling, pus or fever warrants medical advice because it may indicate infection rather than the expected local treatment reaction.

Ask how confident the diagnosis is, whether any part looks suitable for biopsy, and whether nearby skin needs field treatment. Clarify how treatment may affect hand use, washing and sun protection during healing, as well as the plan for checking for new lesions.