Dark actinic keratosis: what to know

Actinic keratosis, also called solar keratosis, develops in skin that has received repeated ultraviolet exposure. It may feel sandpapery, scaly or crusted and can be pink, tan, brown or red. Common sites include the face, ears, scalp, forearms and backs of the hands. A darker colour does not establish the diagnosis: a dermatologist may need to distinguish it from a sun spot, irritated lesion or squamous cell carcinoma. Read about [Sun-Damaged Skin](/conditions/photoaging/) and [Squamous Cell Carcinoma](/conditions/squamous-cell-carcinoma/).

Arrange a skin examination, especially if the patch is new, changing or repeatedly rough. The clinician may inspect the area closely and decide whether sampling is needed. Depending on the number, thickness and location of lesions, options can include freezing with [Cryotherapy (Lesion Removal)](/treatments/surgical-dermatology/cryotherapy-lesion-removal/), a prescribed cream such as [Imiquimod Treatment](/treatments/medical-dermatology/imiquimod-therapy/) or [Topical 5-Fluorouracil](/treatments/medical-dermatology/topical-5-fluorouracil/), or [Photodynamic Therapy](/treatments/laser-and-energy/photodynamic-therapy/). Use sun protection and avoid picking the surface while waiting.

Seek prompt dermatology assessment if the spot grows, becomes tender, bleeds, forms a persistent sore or develops a thicker, firm area. A lesion that changes quickly or looks unlike your other marks also deserves review. [Skin Cancer Screening](/treatments/diagnostics-and-testing/skin-cancer-screening/) can help when several lesions need checking. If a confirmed skin cancer has been treated, [Follow-Up After Cancer Treatment](/treatments/survivorship-and-rehabilitation/post-treatment-surveillance/) may be part of ongoing care.

Could this be actinic keratosis or another lesion? Does the dark colour or surface change alter the need for a biopsy? Which treatment fits its site and thickness? How should I protect the area from further sun exposure?