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Actinic keratosis

Alternative Name

Cancer - skin - squamous cell; Skin cancer - squamous cell; Nonmelanoma skin cancer - squamous cell; NMSC - squamous cell


Actinic keratoses are precancerous growths on the skin. They are caused by many years of sun exposure and are found most commonly on chronically sun exposed skin on the head (face, scalp, lower lip, ears) as well as exposed areas on the arms and legs. These are considered to be the earliest stage of skin cancer and may progress to Squamous cell carcinoma if left alone. So, if identified, you should seek Dermatologic evaluation and treatment.

Actinic keratoses are felt by most to be pre-cancerous areas on chronically sun exposed areas. A portion of these if left alone may progress to Squamous cell carcinoma and so it is best to treat these as well.

Review Date: 5/12/2011

Reviewed By: Sandra Osswald, MD

Risk Factors

Chronic sun exposure
Having fair skin and light hair/eyes such as blond or red hair and blue or green eyes
History of multiple sunburns
Older age

Actinic Keratosis
Illustration of the anatomy of the biliary system
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Actinic keratoses often present as dry, scaly, rough bumps. They can also present as a scaly patch on the skin that is pink, red, the same color as the skin or even brown or grey. Long standing lesions can develop a horny appearance. They can be single or multiple and occur most frequently on chronically sun damaged skin of the head and exposed areas on the arms/hands and legs.


Diagnosis begins with a skin examination. If there are any suspicious lesions noted on examination, your doctor will recommend treatment options to you. Your doctor may recommend a biopsy to evaluate for progression to skin cancer before therapy depending on its size and characteristics. This procedure involves removing the lesion or a sample of the lesion of concern so that it may be sent for pathologic evaluation. Pathologic evaluation can determine if the lesion is a skin cancer and if so, what type of skin cancer it is. Biopsies can usually be performed as an outpatient office procedure under local anesthesia. When the pathology is reviewed, you are then notified of the results and if any further testing or treatment is recommended.


Treatment of actinic keratoses will depend on the size and extent of the lesions.  It may be recommended that certain lesions be biopsied before treatment to evaluate for progression to skin cancer.

Treatment options will be discussed with you.  Treatment options may include:

Cryotherapy or freezing lesions with liquid nitrogen.

Electrodesiccation and curettage. The doctor will scrape away abnormal cells using a curette and use an electric needle to destroy cells.

Blu-U photodynamic therapy.  This procedure involves using a topical medicine that makes cancer cells sensitive to light and then applying light therapy to destroy cancer cells.

Chemotherapy, topical, retinoid and biologic therapies.  There are a variety of topical medications, such as 5 fluorouracil (Efudex, Carac), that can be used to destroy cancerous cells, as well as immunomodulators that can alter your immune system.  These therapies are particularly useful for those with multiple lesions.


There are many ways you can help prevent actinic keratoses.

Seek the shade, especially between 10am and 4pm.
Cover up your skin with dark, tight woven clothing over your arms and legs; wear large brimmed hats and sunglasses.
Wear sunscreen everyday that provides broad spectrum coverage, both UVA and UVB, and is at least SPF30.

Don't use tanning beds and don't burn.

Examine your skin from head to toe every month and see your doctor every year for a professional skin exam.


If you would like to request an appointment with a physician, or if there is a direct referral from a physician, please call:

Appointments: (210) 450-9840

Fax: (210) 450-6092