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Actinic Keratoses

What is an Actinic Keratosis?

Actinic Keratoses (AKs) are scaly or crusty spots that appear on the surface of the skin. They are precancerous lesions that result from chronic sun exposure. Actinic keratoses are extremely common, with nearly 40 million Americans affected. Some of these lesions will develop into squamous cell carcinoma, a type of skin cancer. These spots can be found on chronically sun exposed areas such as the face, ears, neck, balding scalp, lips, and hands. Early diagnosis and treatment of these lesions is key in preventing further development to skin cancer.

What do AKs look like?

An AK looks like an irregular crusty pigmented lesion or dry patch commonly on chronically sun exposed skin. The appearance can vary widely and many times AKs can be felt more easily than seen. They can range in size from a spot as small as a pinhead to over an inch. They may be dark or light, or the same color as one’s skin. The borders are often ill-defined and irregular. Occasionally they itch or produce a tender sensation. AKs can disappear only to reappear again. An AK located on the lower lip is known as actinic cheililtis. If these lesions begin to ulcerate, bleed, thicken, or become tender, it is suspicious for skin cancer.

Who is at risk?

Fair-skinned individuals with a history of unprotected ultraviolet light exposure (either from the sun or a tanning bed) are at greatest risk for developing AKs. A history of sunburn also raises the risk, especially if early on in childhood or adolescence. AKs are common in people over the age of 40. However, AKs can develop in younger people who live in climates where it is sunny year round, where the accumulation of sun exposure is greater.

How are AKs diagnosed?

AKs are diagnosed by visual and physical evaluation by a trained dermatologist. Spots that keep coming back or won’t heal should warrant an evaluation.

How are AKs treated?

Treatment options are determined by the number of lesions, their locations, your age, and health. Options include:

  • Cryosurgery is a common therapy for AKs because it can be done quickly and efficiently in the office. Liquid nitrogen is used to quickly freeze the lesions and eliminate the precancerous cells. The skin may redden and blister before the lesion falls off and is replaced by new skin.
  • Topical therapies may be used if AKs involve a larger area of the skin and are poorly defined. These therapies include topical chemotherapy agents such as 5-fluorouracil, and immunomodulatory agents such as imiquimod and ingenol mebutate. With these therapies, one can expect the skin to turn red and blister over several weeks as AKs are targeted.
  • Photodynamic Therapy (PDT) is an in-office treatment that involves the application of a special light sensitive chemical to the area to be treated. The precancerous cells absorb the chemical. When the area is exposed to light, the abnormal cells are killed.
  • Chemical peels involve the application of a chemical solution that peels away the AKs. The top layers of skin are replaced in approximately 1 week with a healthier layer of skin.
  • Surgical biopsy may be warranted for sampling of the lesion if there is a concern for development of an underlying skin cancer.

Combination therapy may be recommended. The appropriate treatment will be determined with Dr. Schuering, personalized for your specific circumstances and needs.


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