Actinic keratoses (AKs) are so common today that treatment for these lesions ranks as one of the most frequent reasons that people consult a dermatologist. Most people simply want the lesion removed for cosmetic reasons and are unaware that they have developed a potentially serious skin condition that can progress to squamous cell carcinoma, a type of skin cancer that can spread.

You may feel an AK before you see it. A small patch of skin can feel rough, dry, and scaly. While this lesion may not be visible, the surrounding skin usually shows signs of sun damage, such as broken blood vessels, yellowish discoloration, or blotchy pigment.

Visible AKs can take many forms, including:

  • Rough scaly patches, crusts, or sores that range in size from a pinpoint to larger than a quarter. The color varies. Some AKs are red or skin-colored. Others are brown, gray, or yellowish black.

  • Brownish patches, which may be mistaken for age spots.

  • Large patches that resemble a rash can occur when numerous AKs develop; patients often think they have a rash that will not clear.

  • A growth that resembles an animal's horn. The shape may be straight or curved, and the size tends to range from that of a pinhead to a pencil eraser.

The cause of most AKs is unprotected, long-term or intense exposure to the sunís harmful ultraviolet (UV) rays. AKs tend to form in areas that receive the greatest amount of sun exposure, such as the face, lower lip, scalp, ears, neck, forearms, and back of the hands. Some people develop AKs on their legs or trunk.

Since AKs usually occur after years of unprotected sun exposure, most patients do not develop their first AKs until their 60s. However, AKs can appear at any age. Today, dermatologists are finding AKs in their younger patients. Some patients are in their teens.

Suspicious Lesion, See a Dermatologist
If you believe you have an AK, be sure to contact a dermatologist. Dermatologists receive extensive, specialized training in the detection and treatment skin conditions. Early diagnosis and treatment can prevent an AK from progressing to a type of skin cancer called squamous cell carcinoma. To see the many shapes and colors that AKs can take, visit What Do AKs Look Like?

Patients who have a specific medical condition may be invited to speak about their experiences at a scientific conference. The following story was told during a conference about AKs. To protect this patient's privacy, his name does not appear.

In the early 1960s, a man visited his dermatologist for a rash. The man described this rash as occurring ìall over his head. The doctor prescribed a topical chemotherapy agent called 5-Fluorouracil (5-FU). This medication is effective in treating multiple actinic keratoses (AKs), and today, it is one of the most frequently used treatments for actinic keratoses (AKs) in the United States. However, after using 5-FU twice daily for two weeks, the man stopped because he said he felt like he "was on fire".

During an appointment with a dermatologist in 1994, the man said his dermatologist examined "a little something on my nose." The dermatologist said, "I don't like that", and removed the lesion. The biopsy report revealed that the little something was squamous cell carcinoma, a type of skin cancer. A week later, the cancerous lesion had grown back.

Since then, this patient has endured more than 14 surgeries and extensive radiation therapy. After radiation therapy on his neck and head, this patient says he has felt "debilitated and beat up ever since."

This man's story illustrates the importance of early diagnosis and treatment for AKs. AKs have the potential to progress to squamous cell carcinoma, a type of skin cancer that can spread. By the time this squamous cell carcinoma was biopsied, it had grown, according to the Mohs surgeon who treated him, "right down to the bone."

With early treatment, the cure rate for AKs often exceeds 90%. Today several treatment options, which have been approved by the U.S. Food and Drug Administration (FDA), are available. These include cryosurgery (freezing), a cream that stimulates the patient's own immune system to destroy the lesions, surgical removal, and laser therapy. Most procedures can be safely and effectively performed in a dermatologistís office.

Some treatment options require the patient to apply a topical medication at home. If your dermatologist prescribes a topical treatment that causes too much discomfort, be sure let your dermatologist know. The amount and/or times that you apply the medication often can be changed to make the treatment tolerable.

If you spot a new growth or notice a change to an existing lesion, be sure to contact a dermatologist. Even if you cannot see a lesion but can feel a patch of dry, rough, scaly skin, be sure to see a dermatologist. AKs often can be felt before they are seen. The man who spoke about his experiences at the conference recalls the little something on his nose began as" a little rough spot just below the bridge of my nose". 

For more information about treatments used to treat AKs, visit Treatment Options.

The American Academy of Dermatology is developing a new magazine that will provide readers with in-depth articles about a variety of topics related to skin, hair, and nail health.  As a subscriber to the Academy's Public Resource Newsletter, we value your interest and input. Please take a short survey.

You need more than a bit of sunscreen on a sunny summer day to protect your child's skin from the sun's harmful ultraviolet (UV) rays.
To give parents the information they need, the American Academy of Dermatology recently partnered with Parents Magazine to create a special section about sun safety. You will find this essential guide at Get Serious About Sun Safety.


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