What is actinic keratosis?
Actinic keratoses are common, sun-related skin changes. Understanding what they are can make it easier to know when to have your skin checked.
Caused by long-term sun exposure
Actinic keratoses, sometimes called solar keratoses, are rough patches that form on skin with years of cumulative ultraviolet (UV) exposure. Even in Alaska, time outdoors, snow reflection, and travel to sunnier places can add up over a lifetime.
Considered precancerous
Dermatology providers think of actinic keratoses as precancerous spots. Most do not turn into skin cancer, but a small number can develop into squamous cell carcinoma over time, which is why evaluation matters.
Often found on sun-exposed skin
They commonly appear on the face, scalp, ears, neck, forearms, and the backs of the hands. Patients in Anchorage and Wasilla often first notice them after years of work or recreation outdoors.
Best identified in person
Actinic keratoses can look and feel similar to other spots. A dermatology provider can examine your skin closely and tell you what each spot is more reliably than a photo or a search engine.
What these spots can look or feel like
Actinic keratoses can vary from person to person, and a spot that fits this description still needs to be evaluated in person to know what it actually is.
Rough or sandpapery to the touch
Many actinic keratoses are easier to feel than to see. A patch of skin that catches your fingertip like fine sandpaper is a classic clue.
Scaly, dry, or flaky patches
They often show up as small areas of dry, scaly, or flaking skin that do not fully smooth out even with moisturizing.
Pink, red, tan, or skin-colored
Color can vary. Some are pink or red, some are tan or brown, and some are close to your usual skin color but stand out by texture.
May come and go
Some spots seem to improve for a while and then return in the same place. Spots that keep coming back in one area are worth having a provider look at.
Sometimes itchy or tender
Actinic keratoses can occasionally itch, burn, or feel tender, especially after sun exposure. They are not always painful, however.
Often more than one at a time
Many patients have several actinic keratoses across an area of sun-exposed skin rather than a single isolated spot.
Why treatment may be recommended
Not every spot has to be treated, and your provider walks through the reasoning with you. A few of the most common reasons treatment is suggested are below.
Reduce the risk of progression
Treating actinic keratoses can help lower the chance that an individual spot eventually develops into a squamous cell skin cancer.
Get a closer look when something stands out
If a spot looks unusual, is growing, or does not behave like the others, a biopsy can help clarify whether it is a simple actinic keratosis or something that needs different care.
Address symptoms
Treatment can also help with rough texture, itching, tenderness, or the appearance of repeatedly scaly patches.
Set up a long-term plan
Many patients with one actinic keratosis go on to develop others over time. Evaluation is also a chance to plan how often your skin should be checked going forward.
The decision to treat any specific spot is made together at the visit, after your skin has been examined in person.
Common treatment options
There are several effective ways to treat actinic keratoses. The right approach for you depends on how many spots are present, where they are, and what your skin has responded to in the past.
Cryotherapy (freezing)
Liquid nitrogen is applied to individual spots in the office. The area typically blisters or scabs briefly and then heals. This is a common option for a small number of well-defined spots.
Topical prescription treatments
Prescription creams or gels can be applied at home over a defined course to treat larger areas with multiple actinic keratoses. Your provider explains what to expect during treatment and how the skin usually responds.
Light-based and field treatments
For broad areas of sun damage, in-office field treatments such as photodynamic therapy may be considered. These approaches treat visible spots and some surrounding sun-damaged skin in a single session or short series.
Biopsy when a spot stands out
If a spot looks atypical, is changing, or is not responding to treatment, a small biopsy may be recommended so the tissue can be looked at under a microscope. This helps confirm what the spot is and guide next steps.
Combination and tailored plans
Many patients do best with a combination of approaches over time, depending on how many spots are present, where they are, and how they have responded to past treatment.
Plans are matched to your skin
There is no single 'best' treatment that fits everyone. Your provider reviews the options that are most appropriate for your skin, your goals, and your medical history at the visit.
Skin cancer prevention and follow-up
Treating individual spots is one part of the plan. Reducing future sun damage and keeping up with skin checks are the other half.
Daily broad-spectrum sunscreen
Using a broad-spectrum sunscreen on exposed skin, including in winter and on cloudy days, helps reduce the ongoing UV exposure that contributes to new spots.
Sun-protective clothing and hats
Wide-brimmed hats, long sleeves, and UV-blocking sunglasses are a simple, effective layer of protection, especially for outdoor work or recreation in Alaska.
Be mindful of reflective surfaces
Snow, water, and ice reflect UV light and increase your exposure. Sun protection is just as important during ski season as during summer.
Avoid indoor tanning
Indoor tanning beds add significant additional UV exposure and are best avoided.
Periodic skin checks
Patients with a history of actinic keratoses often benefit from scheduled skin checks. Your provider can recommend an interval that fits your skin and history.
Tell your provider about changes
Between visits, let your dermatology team know about new spots, spots that are growing, or sores that will not heal.
Schedule evaluation in Anchorage or Wasilla
Advanced Dermatology of Alaska sees patients for actinic keratoses and sun-damaged skin at both Alaska offices. Choose the location that is most convenient for you.
Frequently asked questions
Is actinic keratosis skin cancer?
Actinic keratosis is not skin cancer, but it is considered precancerous. Most spots do not become cancer, however a small number can develop into squamous cell carcinoma over time. That is why dermatology providers usually recommend evaluating and, when appropriate, treating them rather than ignoring them.
What does actinic keratosis feel like?
These spots are often easier to feel than to see. The classic description is a small area of skin that feels rough or sandpapery, sometimes with a thin scale or dry patch on top. Some spots can also itch, burn, or feel tender, especially after sun exposure.
Can actinic keratosis go away on its own?
Some individual spots may come and go on their own for a time, but they often return in the same area. Because some actinic keratoses can eventually progress, having them evaluated rather than relying on them to fully resolve on their own is generally the safer approach.
Why might a biopsy be needed?
If a spot looks unusual, is growing, is thicker than the others, or is not responding to treatment, your provider may recommend a small biopsy. The sample is reviewed under a microscope to confirm what the spot is and to make sure something that needs different care has not been missed.
How can I prevent more sun-damaged spots?
Daily broad-spectrum sunscreen, sun-protective clothing and hats, being mindful of reflective surfaces such as snow and water, avoiding indoor tanning, and keeping up with scheduled skin checks all help. Even simple, consistent sun protection adds up over a lifetime.
Medical disclaimer
The information on this page is for general education only and is not medical advice. Actinic keratoses can look similar to other skin spots, including some skin cancers. Diagnosis and treatment decisions require an in-person evaluation by a qualified healthcare professional. If you have a spot that is changing, growing, bleeding, or not healing, please schedule a visit.