Diagnosis

Your doctor will likely be able to determine whether you have an actinic keratosis simply by examining your skin. If there's any doubt, he or she may do other tests, such as a skin biopsy. During a skin biopsy, your doctor takes a small sample of your skin for analysis in a lab. A biopsy can usually be done in a doctor's office after a numbing injection.

Even after treatment for actinic keratosis, your doctor will likely suggest that you have your skin checked at least once a year for signs of skin cancer.

Treatment

An actinic keratosis sometimes disappears on its own, but it typically returns after more sun exposure. Because it's impossible to tell which patches or lesions will develop into skin cancer, actinic keratoses are usually removed as a precaution.

Medications

If you have several actinic keratoses, you may be better served by treating the entire affected area. Prescription products that can be applied to your skin for this purpose include:

  • Fluorouracil cream (Carac, Fluoroplex, Efudex)
  • Imiquimod cream (Aldara, Zyclara)
  • Ingenol mebutate gel (Picato)
  • Diclofenac gel (Voltaren, Solaraze)

These creams may cause redness, scaling or a burning sensation for a few weeks.

Photodynamic therapy

In photodynamic therapy, your doctor applies a chemical solution to the affected skin that makes it sensitive to light. He or she then exposes the area to artificial light to destroy the damaged skin cells. Side effects may include redness, swelling and a burning sensation during therapy.

Surgical and other procedures

If you have only a few actinic keratoses, your doctor may recommend removing them. The most common methods include:

  • Freezing (cryotherapy). Actinic keratoses can be removed by freezing them with liquid nitrogen. Your doctor applies the substance to the affected skin, which causes blistering or peeling. As your skin heals, the lesions slough off, allowing new skin to appear. Cryotherapy is the most common treatment. It takes only a few minutes and can be done in your doctor's office. Side effects may include blisters, scarring, changes to skin texture, infection and darkening of the skin at the site of treatment.
  • Scraping (curettage). In this procedure, your surgeon uses a device called a curet to scrape off damaged cells. Scraping may be followed by electrosurgery, in which the doctor uses a pencil-shaped instrument to cut and destroy the affected tissue with an electric current. This procedure requires a local anesthetic. Side effects may include infection, scarring and changes in skin coloration at the site of treatment.

Preparing for your appointment

You're likely to start by seeing your family doctor or primary care doctor. In some cases when you call to set up an appointment, you may be referred directly to a specialist in skin diseases (dermatologist).

What you can do

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your appointment. For actinic keratoses, some basic questions to ask your doctor include:

  • Are tests needed to confirm the diagnosis?
  • What are my treatment options and the pros and cons of each?
  • What will the treatments cost? Does medical insurance cover these costs?
  • What suspicious changes in my skin should I look for?
  • What kind of follow-up should I expect?

What to expect from your doctor

Questions your doctor may ask you include:

  • When did you first notice the lesions?
  • Have you noticed multiple lesions?
  • Have you noticed any changes in the appearance of the lesions?
  • Is the condition bothersome?
  • Have you experienced frequent or severe sunburns?
  • How often are you exposed to sun or UV radiation?
  • Do you regularly protect your skin from UV radiation?
Aug. 11, 2017
References
  1. Goldsmith LA, et al., eds. Epithelial precancerous lesions. In: Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.com. Accessed Aug. 5, 2016.
  2. Padilla RS. Epidemiology, natural history and diagnosis of actinic keratosis. http://www.uptodate.com/home. Accessed Aug. 5, 2016.
  3. Wolff K, et al. Photosensitivity, photo-induced disorders and disorders by ionizing radiation. In: Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology. 7th ed. New York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com. Accessed June 19, 2015.
  4. Actinic keratosis. American Academy of Dermatology. http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a---d/actinic-keratosis. Accessed Aug. 5, 2016.
  5. Gibson LE (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 21, 2016.
  6. Jorizzo J. Treatment of actinic keratosis. http://www.uptodate.com/home. Accessed Aug. 5, 2016.
  7. FDA sheds light on sunscreens. Food and Drug Administration. http://www.fda.gov/forconsumers/consumerupdates/ucm258416.htm. Accessed Aug. 5, 2016.
  8. AskMayoExpert. Actinic keratosis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
  9. Habif TP. Light-related diseases and disorders of pigmentation. In: Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th ed. Maryland Heights, Mo.: Elsevier; 2016. http://www.clinicalkey.com. Accessed June 19, 2015.
  10. Sunscreen FAQs. American Academy of Dermatology. https://www.aad.org/media/stats/prevention-and-care/sunscreen-faqs. Accessed Sept. 26, 2016.
  11. Lebwohl M. Actinic keratosis. JAMA. 2016;315:1394.