Actinic keratosis

Your health care provider will likely be able to determine whether you have an actinic keratosis simply by looking at your skin. If there's any doubt, your health care provider may do other tests, such as a skin biopsy. During a skin biopsy, a small sample of skin is taken for analysis in a lab. A biopsy can usually be done in a clinic after a numbing injection.

Even after treatment for actinic keratosis, your health care provider might suggest that you have your skin checked at least once a year for signs of skin cancer.

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.

Medicines

If you have several actinic keratoses, your health care provider might prescribe a medicated cream or gel to remove them, such as fluorouracil (Carac, Efudex others), imiquimod (Aldara, Zyclara) or diclofenac. These products might cause inflamed skin, 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 health care provider 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 health care provider'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 health care provider uses a device called a curet to scrape off damaged cells. Scraping may be followed by electrosurgery, in which a pencil-shaped instrument is used 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 health care provider 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 health care provider 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 inflamed skin, swelling and a burning sensation during therapy.

You're likely to start by seeing your primary care provider. 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 health care provider 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 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 health care provider may ask you include:

• When did you first notice the patches or spots?
• Have you noticed more than one patch or spot?
• Have you noticed more changes in the affected skin?
• Is the condition bothersome?
• Have you had many sunburns or very bad sunburns?
• How often are you exposed to sun or ultraviolet (UV) radiation?
• Do you protect your skin from UV radiation when you go outdoors?