Actinic keratosis: appearance, meaning and next steps

It commonly develops on skin that has received repeated ultraviolet exposure, such as the face, scalp, ears, forearms or backs of the hands. A clinician may call it solar keratosis or a precancerous sun spot.

A patch may be easier to feel than see. It can have a dry, sandpaper-like surface and may be flat, raised or crusted. Its colour can resemble surrounding skin or appear pink, red, brown or grey. Some areas sting, itch or feel tender, while others cause no discomfort.

The changes arise when sun-damaged skin cells grow abnormally near the surface. Actinic keratosis is not the same as invasive skin cancer, but some lesions can develop into squamous cell carcinoma. Appearance alone cannot reliably separate it from other scaly spots, so a skin examination is useful.

Arrange a routine dermatology appointment for a persistent rough or scaly area, especially on sun-exposed skin. Avoid picking or scraping it. Note when you first noticed it and whether its size, texture, colour or sensation has changed.

Treatment depends on whether there is one distinct lesion or a broader field of sun damage. Options can include freezing an individual spot, prescription creams that treat abnormal cells, or photodynamic therapy. Your clinician may examine the rest of your sun-exposed skin and choose a biopsy if the diagnosis is uncertain or the lesion looks concerning.

Protect exposed skin with shade, clothing, a hat and broad-spectrum sunscreen. Sun protection helps limit further ultraviolet injury, but it does not remove an established lesion.

Request prompt assessment if the area grows quickly, becomes thick or firm, repeatedly bleeds, forms an open sore, or develops persistent pain. These changes do not establish a diagnosis, but they can warrant closer examination and sometimes a biopsy.

Also return for review if a treated spot fails to heal as expected, comes back, or a new change appears nearby. Seek urgent help for spreading redness, warmth, swelling, pus or fever after a procedure, because these can indicate infection.

Ask whether the diagnosis is clear from examination or whether a biopsy is advisable; whether treatment should target one spot or a wider sun-damaged area; what skin reaction to expect; how to care for the site; and how often your skin should be checked afterward.