Actinic Keratosis Diagnosis: What Does It Mean and What Happens Next?

An actinic keratosis diagnosis means a clinician has found a rough, dry or scaly patch caused by sun damage. It is also called a solar keratosis. It is not skin cancer, but it is described as precancerous because a small number can change into a skin cancer called squamous cell carcinoma.

The American Academy of Dermatology (AAD) explains that sun damage builds up over the years, and that people who use or have used tanning beds or sunlamps also get these patches. Many people who develop them are otherwise healthy. They are not contagious.

This guide is for adults who have been told they have an actinic keratosis, by examination or on a biopsy report. It explains the general picture and helps you prepare questions. It cannot tell you what a particular spot is or which treatment you need.

The NHS advises seeing a GP if you notice new patches, if a patch appears on your lips, or if a patch bleeds, grows, changes colour, becomes tender or turns into a lump. Do not wait for a routine follow-up date if one of these changes happens.

The National Cancer Institute (NCI) lists possible signs of squamous cell carcinoma, which is the skin cancer an actinic keratosis can occasionally become. The NHS also advises getting checked for a growth or area of skin that hurts, itches, bleeds, crusts or scabs for more than 4 weeks.

• A sore that does not heal.
• Skin that is scaly, bleeding or crusty.
• A raised red or reddish-brown area, or a firm bump.
• A firm area that looks like a scar.
• A new or changing mole, or any dark mark that changes in size, shape or colour, which needs its own assessment.

The NHS describes the patches as rough, dry and scaly, sometimes feeling like sandpaper, and usually 1 to 2 cm across. They may be the same colour as the skin or look pink, red or brown, and they can itch. The AAD notes that some look like a new age spot, a pimple or a patch of irritated skin.

They usually appear on skin that gets the most sun, such as the face, ears, scalp, neck, hands, arms and lips. An actinic keratosis on the lip is called actinic cheilitis. People often have more than one, and some can be felt before they are easy to see.

The risk for any single patch is small. The NHS describes it as a small chance. NCI's summary for health professionals says the rate of progression to squamous cell carcinoma is extremely low and that most actinic keratoses do not become cancer. It cites one prospective study in which progression was less than 1 in 1,000 per year.

Some patches also clear on their own. NCI notes that an actinic keratosis may disappear without treatment. However, it is still treated because it may develop into cancer, and skin with this kind of damage can keep producing new patches. That is why the AAD stresses regular skin checks after the diagnosis.

These figures describe groups of people, not your skin. Your clinician weighs the number of patches, how they look and feel, your history of skin cancer and other health conditions, such as a weakened immune system.

Treatment is usually recommended, according to the AAD. The NHS notes that a single patch is sometimes watched first to see if it clears, while several patches, or a patch that is painful or itchy, are usually treated. Options fall into two broad groups. Your dermatologist may combine them.

• Freezing (cryotherapy or cryosurgery): a very cold substance such as liquid nitrogen makes the patch blister and fall off over the following weeks. Some patches need repeat treatment.
• Scraping or cutting (curettage or minor surgery): used for thicker patches and done under local anaesthetic.
• Photodynamic therapy (PDT): a light-sensitising cream or solution is applied and then activated with a special light.
• Medical chemical peels and laser resurfacing: used in some cases, such as on the lip.
• Prescription creams or gels used at home: often chosen when there are many patches over an area of skin. Each has its own schedule and skin reactions, which your prescriber should explain.

Many actinic keratoses are diagnosed by a careful skin examination. The AAD notes that the dermatologist also checks for signs of skin cancer at the same visit. If a patch looks thicker, more tender or different from the others, a sample may be taken. The AAD explains that examining tissue under a microscope is the only way to tell for sure whether a growth is skin cancer.

If you have a biopsy report, ask what was sampled, whether it showed only actinic keratosis, and whether the whole patch was removed or only part of it. Keep a copy with the date and the body site, because it helps with later comparisons.

Sun protection is the main step you can take. The NHS advises sunscreen of at least SPF 30 applied before going out and reapplied regularly, a hat and clothing that covers the arms and legs, and staying out of direct sun between 11am and 3pm. It also advises avoiding sunbathing, sunlamps and sunbeds.

The NHS adds that people who always cover up outdoors may not get enough vitamin D from sunlight and may want to ask about a daily supplement. Check your skin regularly, using a mirror or help from someone else for your scalp, ears and back. Photos taken in the same light can make changes easier to compare.

Write down the answers or ask for them in your visit summary.

• Was this diagnosed by examination or by biopsy, and does anything in the report need further action?
• Which patches are you treating, which are you watching, and why?
• What should the treated skin look like during healing, and what reaction is too much?
• Which changes should make me book an earlier appointment rather than wait?
• How often should I have a skin check, and who will arrange it?
• Do any of my medicines or health conditions change the treatment options?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with an actinic keratosis diagnosis described their patches, treatment and follow-up can help you notice questions you had not thought to ask. Other people's cases cannot show what your skin needs, and they are not a substitute for an examination. Take your questions to the clinician who can see your skin.