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, your doctor 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 might suggest that you have your skin checked at least once a year for signs of skin cancer.

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Treatment

An actinic keratosis sometimes disappears on its own but might return after more sun exposure. It's hard to tell which actinic keratoses will develop into skin cancer, so they're usually removed as a precaution.

Medications

If you have several actinic keratoses, your doctor might prescribe a medicated cream or gel to remove them, such as fluorouracil (Carac, Fluoroplex, others), imiquimod (Aldara, Zyclara), ingenol mebutate or diclofenac (Solaraze). These products might cause redness, scaling or a burning sensation for a few weeks.

Surgical and other procedures

Many methods are used to remove actinic keratosis, including:

  • 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 damaged cells 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 changes in skin color of the affected area.
  • Scraping (curettage). In this procedure, your doctor 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 local anesthesia. Side effects may include infection, scarring and changes in skin color of the affected area.
  • Laser therapy. This technique is increasingly used to treat actinic keratosis. Your doctor uses an ablative laser device to destroy the patch, allowing new skin to appear. Side effects may include scarring and discoloration of the affected skin.
  • Photodynamic therapy. Your doctor might apply a light-sensitive chemical solution to the affected skin and then expose it to a special light that will destroy the actinic keratosis. Side effects may include redness, swelling and a burning sensation during therapy.

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 patches or spots?
  • Have you noticed multiple patches or spots?
  • Have you noticed any changes in the appearance of the affected skin?
  • 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?
Jan. 13, 2021
  1. Kang S, et al., eds. Epithelial precancerous lesions. In: Fitzpatrick's Dermatology. 9th ed. McGraw Hill; 2019. https://accessmedicine.mhmedical.com. Accessed Sept. 30, 2020.
  2. Padilla RS. Epidemiology, natural history, and diagnosis of actinic keratosis. https://www.uptodate.com/contents/search. Accessed Sept. 30, 2020.
  3. Aasi SZ, et al. Treatment and prognosis of low-risk cutaneous squamous cell carcinoma. https://www.uptodate.com/contents/search. Accessed Nov. 12, 2020.
  4. Actinic keratosis. American Academy of Dermatology. https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a---d/actinic-keratosis. Accessed Sept. 30, 2020.
  5. Gibson LE (expert opinion). Mayo Clinic. Nov. 25, 2020.
  6. Lebwohl M. Actinic keratosis. JAMA. 2016; doi:10.1001/jama.2016.3065.
  7. AskMayoExpert. Actinic keratosis. Mayo Clinic; 2020.
  8. Sunscreen FAQs. American Academy of Dermatology. https://www.aad.org/media/stats/prevention-and-care/sunscreen-faqs. Accessed Sept. 30, 2020.
  9. Sunscreen: How to protect your skin from the sun. U.S. Food and Drug Administration. https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm239463.htm. Accessed Dec. 23, 2020.
  10. AskMayoExpert.Sunburn. Mayo Clinic; 2020.

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