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Actinic Keratosis (A Precancerous Condition)

What is actinic keratosis?

Actinic keratosis, also known as a solar keratosis, is a scaly or crusty bump that arises on the skin surface. The base may be light or dark, tan, pink, red, a combination of these, or the same color as the skin. The scale or crust may be horny, dry, and rough, and is often recognized by touch rather than sight. Occasionally, it itches or produces a pricking or tender sensation.

Actinic keratosis can be the first step in the development of squamous cell skin cancer, and, therefore, is considered a precancerous skin condition. The presence of actinic keratoses indicates that sun damage has occurred and that skin cancer can develop.

How does an actinic keratosis develop?

An actinic keratosis develops slowly and most likely appears on the face, ears, bald scalp, neck, backs of hands and forearms, and lips. It tends to lie flat against the skin of the head and neck, but appear elevated on arms and hands. Often, a person will have more than one actinic keratosis lesion. Actinic keratoses that develop on the lip are called actinic cheilitis.

The lesions are usually not life threatening, provided they are detected and treated in the early stages. However, if this is not done, they can sometimes develop into squamous cell carcinomas.

What causes actinic keratosis?

Sun exposure causes almost all actinic keratoses. Sun damage to the skin accumulates over time, so that even a brief exposure adds to the lifetime total. Certain groups of people are more at risk than others, including the following:

  • People who have fair skin, blonde or red hair, and blue, green, or gray eyes are at the greatest risk, but darker-skinned people can develop keratoses if they expose themselves to the sun without protection.

  • African-Americans rarely have these lesions.

  • Individuals who are immunosuppressed as a result of cancer chemotherapy, acquired immune deficiency syndrome (AIDS), or organ transplantation are also at higher risk.

  • People with certain rare conditions that make the skin very sensitive to the sun's UV rays, such as albinism and xeroderma pigmentosum (XP), are at very high risk 

Millions of Americans have actinic keratoses. Older people are more likely than younger people to develop actinic keratoses, because cumulative sun exposure increases with age.

Treatment for actinic keratosis

Specific treatment for actinic keratosis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent and location of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment for actinic keratosis may include cryotherapy (freezing the lesion), topical chemotherapy (anticancer drugs applied to the skin), minor surgery, or other treatments. Nearly all actinic keratoses can be successfully treated, although in rare cases they may recur (come back). Continued skin examination after treatment is important, as people who have had them often develop new ones.