Actinic keratosis of the skin

Repeated ultraviolet exposure alters keratinocytes in the outer skin layer. The result may be a small gritty patch, adherent scale or crust on sites such as the face, ears, scalp, forearms or backs of the hands. The area can be skin-coloured, pink, red or brown, and it may itch, sting or remain symptom-free.

The change is classed as premalignant: it is not invasive cancer, yet it has the capacity to progress to squamous cell carcinoma. Similar-looking patches have other causes, so location and texture alone cannot confirm the diagnosis.

Have a persistent scaly area examined, and point out any previous skin cancers or immune-suppressing medicines because those details affect management. A clinician may use close visual inspection and touch; a thick or atypical lesion may need biopsy. Treatment choices include cryotherapy for selected spots and prescription creams or photodynamic therapy for broader fields.

Protect exposed skin with shade, clothing, a hat and broad-spectrum sunscreen, and avoid intentional tanning. Check familiar sun-exposed areas regularly in bright light. Photos can help track one lesion, but they do not replace an examination of texture or depth.

Arrange prompt clinical review if the patch rapidly enlarges, becomes thick or firm, develops ongoing tenderness, bleeds repeatedly or breaks down into an ulcer. Seek advice as well if a treated lesion fails to heal as expected or reappears. Such changes can have several explanations, and direct assessment determines whether biopsy or different treatment is needed.

Ask whether you have one lesion or field change, which option suits the body site, how the skin is expected to react, and what aftercare will support healing. It is also useful to clarify which other areas you should monitor and the timing of a follow-up examination.