What You Need To Know About Actinic Keratosis

Regular skin cancer screenings — both in-office with your dermatologist and at-home in front of your mirror — are a vital part of preventative medicine. Skin cancer is the most commonly diagnosed type of cancer in the United States, but it’s also often considered the most preventable. While we place a lot of emphasis on how to spot melanoma (the most dangerous form of skin cancer), it’s equally as important to be familiar with the warning signs of the skin growths that can turn into squamous and basal cell carcinoma.

From diagnosis to treatment, we’re breaking down everything you need to know about actinic keratosis (AK), the most common pre-cancer that forms on skin damaged by chronic exposure to ultraviolet rays (read: the sun) .

What Is Actinic Keratosis?

Actinic keratoses (also known as solar keratoses) are pre-cancers that exhibit as scaly patches on your skin due to years of sun exposure. They are most commonly found on the face, lips, ears, neck, scalp, and the backs of the hands. If left untreated, they can turn into squamous cell carcinoma – the second most common form of skin cancer after basal cell carcinoma.

According to the Skin Cancer Foundation, 58 million Americans have one or more AK and 5 to 10 percent of those spots become canercous. “These rough patches are early warning signs saying, ‘catch us before we turn into cancer,’” explains Adriana Lombardi, MD, a board certified dermatologist at the Skin Cancer & Cosmetic Surgery Center of New Jersey. “We want to treat them as soon as we see them, so they don’t have a chance.”

People who have a long history of sunburns or who have used tanning beds often begin noticing actinic keratoses around or after the age of 50. This is especially true of those with fair skin. The longer they sit on the top layer of your skin, the thicker and deeper they get. No surprise here, that makes them more difficult to remove.

Why It's Often Misdiagnosed

Actinic keratosis can look like (and be mistaken for) a rash since it presents as dry, scaly patches. To avoid the trapping, “it’s important for people to understand what to look for when checking their skin for signs of cancer,” says Angela Lamb, MD, a board certified dermatologist in New York City.

There’s a lot of awareness around the ABCDE’s of melanoma (asymmetry, border, color, diameter, and evolving) for early detection. But, when it comes to squamous and basal cell carcinoma, there are other things to keep an eye out for. “I tell my patients to look for any sudden changes like bleeding, itching, and burning,” she explains.

How to Treat Actinic Keratosis

Once actinic keratosis is identified, there are different treatment options. Which one is best for you will depend on a few key factors:

1. The number of lesions you have
2. Your skin type
3. The time of year

Your dermatologist may freeze it off in the office with liquid nitrogen. Usually, a spot that is frozen off won’t return. If it does, then it’s time to consider a biopsy to make sure there’s nothing deeper to be concerned about.

Aminolevulinic acid is often employed to treat large areas, while topical chemotherapy or anti-inflammatory agents can be used at home for eight to 12 weeks. Both Dr. Lombardi and Dr. Lamb recommend following up with your dermatologist every three to six months for checkups after treatment for AK to monitor the treatment area and check the body for new spots.

How to Prevent Actinic Keratosis

Actinic keratoses are the result of years of cumulative damage, so, once they appear, there is little you can do to prevent them. With that said, you can seek to avoid them all together by adopting a proactive skincare and sun care routine from a young age. “The number one thing you can do to help prevent actinic keratosis is start using sunscreen at an early age and be diligent about reapplying,” Dr. Lombardi says.

It goes without saying that avoiding sun exposure all together is best, but, when you can’t, staying protected is the next best thing. That means topical sunscreen application, wearing protective clothing (think: sunglasses, hats, and clothing with an ultraviolet protection factor), and even beefing up your supplement routine. Dr. Lombardi suggests adding an ingestible antioxidant, like Heliocare or Isdin Sunisdin, to your daily regimen to fortify skin from the inside out.

In case you needed another excuse to treat yourself to a resurfacing procedure, doing regular chemical peels and laser treatments can help treat pre-cancers by removing the top layer of the skin.

The Takeaway

At the end of the day, we cannot emphasize enough how important it is to consult your dermatologist whenever you notice something that isn’t quite right with your skin. If you’re concerned about rough, scaly patches, they will be able assess the area and suggest the best course of action.

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