Actinic Keratosis (Solar Keratosis)
Medical Author: Alan Rockoff, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
Understanding Actinic Keratosis
Medical Author: Nili N. Alai, MD, FAAD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
 What are actinic keratoses?
Actinic keratoses (AKs) are small, red, rough, scaly, flat spots that feel like dry skin patches. They often occur on sun-exposed areas, such as the nose, ears, face, chest, forearms, and back of the hands. Other common names include AK, AKs, solar keratosis,
precancers, and pre-skin cancers.
At what age do AKs develop?
Experts agree that AKs are most common in older adults and seniors. AKs are extremely rare in children or adolescents.
What are my chances of my precancers becoming skin cancers?
Anywhere from 5%-10% of AKs can potentially go on to become skin cancers. It is not possible to tell which ones will do this. Some AKs will never develop into anything else. Some AKs go away without treatment.
Do actinic keratoses ever turn into melanoma (a deadly form of skin cancer)?
No. While AKs may give rise to skin cancers like squamous cell carcinomas, they do not turn into melanomas. Nevertheless, it is important to keep in mind that people with AKs may be more prone to melanomas simply by having more sun damage.
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What is an actinic keratosis, and what does it look like?
An actinic keratosis (AK), also known as a solar keratosis, is a small, rough
spot occurring on skin that has been chronically exposed to the sun. Actinic
keratoses generally measure in size between 2-6 millimeters in diameter
(between the size of a pencil point and that of an eraser). They are usually
reddish in color, with a rough texture and often have a white or yellowish scale
on top. Actinic keratosis often occurs against a background of sun damage,
including sallowness, wrinkles, and superficial blood vessels.
In addition to feeling rough, actinic keratoses may feel sore or painful when
fingers or clothing rub against them.
Specialized forms of actinic keratoses include cutaneous horns, in which the
skin protrudes in a thick, hornlike manner, and actinic cheilitis, which refers
to scaling and roughness of the lower lip and blurring of the border of the lip
and adjacent skin.
Who is at risk for an actinic keratosis?
Those who develop actinic keratoses tend to be fair-skinned people who have spent a lot of time outdoors at work or at play over the course of many years or who have exposed their skin to indoor tanning. Their skin often becomes wrinkled, mottled, and discolored from sun exposure. Others at risk for developing actinic keratoses include those who have their immune systems suppressed, such as organ transplant patients, as well as patients with psoriasis treated with PUVA therapy (topical long-wave ultraviolet light plus oral chemicals called psoralens.)
Where on the body do actinic keratoses typically occur?
Common locations for actinic keratoses are the face, especially the cheeks and bridge of the nose, scalp, back of the neck, upper chest, as well as the tops of the hands and forearms. Men are more likely to develop AKs on top of the ears, whereas women's hairstyles often protect this area. AKs, especially on the scalp and the backs of the hands, may be hypertrophic
(thickened skin).
What is the significance of an actinic keratosis?
Actinic keratoses are precancerous (premalignant), which means they can develop into skin cancer. However, relatively few of them actually become cancers, a process that typically takes years. When a malignant change does occur, the cancer is called a squamous cell carcinoma. Although squamous cell skin cancers have the potential for metastasis (spreading to other areas), such cancers that arise in preexisting actinic keratoses have a low potential for such spread, and only do so once they have gone deeper and the skin and become invasive. Treating actinic keratoses at an early stage helps prevent this possibility.
When patients are diagnosed with this condition, they often say, "But I
never go out in the sun!" The explanation is that it takes many years or
even decades for these keratoses to develop. Typically, the predisposing sun
exposure may have occurred many years ago. Short periods of sun exposure do not
generally either produce AKs or transform them into skin cancers.
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Sunburn (Sun Poisoning) »
What is sunburn?
Sunburn is an inflammation of the skin that is caused by overexposure to
ultraviolet (UV) radiation from the sun. A similar burn can follow overexposure
to a "sun" (tanning) lamp. UV radiation can also damage the eyes, although no
surface burn is apparent.
Can sunburn cause permanent damage?
Yes. Sunburn early in life increases the risk of developing skin cancer later
on. Repeated overexposure to ultraviolet rays can also
scar,
freckle, dry out,
and wrinkle the skin prematurely. In addition, frequent overexposure to
ultraviolet rays can increase the risk of developing eye cataracts and
macular
degeneration, a leading cause of blindness.
What is UV light?
UV light is radiation energy in the form of invisible light waves. UV light
is emitted by the sun and by tanning lamps.
The sun discharges three types of ultraviolet radiation:
- ultravio...
Read the Sunburn (Sun Poisoning) article »
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