Actinic Keratosis (Solar Keratosis)

  • Medical Author:
    Gary W. Cole, MD, FAAD

    Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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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 radiation. 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 cheeks, bridge of the nose, rim of the ears, scalp, back of the neck, upper chest, and 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 cause thickened skin.

What is the significance of an actinic keratosis?

Actinic keratoses are precancerous (premalignant), which means they can develop into skin cancer. Even though the chance of an individual actinic keratoses progressing into an invasive squamous cell carcinoma is on the order of less than one percent, most patients have many of these lesions and most continue to expose their skin to carcinogenic ultraviolet sunlight. These facts increase the likelihood for the development of invasive skin cancers Squamous cell skin cancers are locally destructive and have a small but real potential for metastasis (spreading to other areas). Treating actinic keratoses at an early stage may help prevent this from happening.

When patients are diagnosed with this condition, they often say, "But I never go out in the sun!" The explanation is that there can be a long delay, even decades for these keratoses to develop. Short periods of sun exposure do not generally either produce AKs or transform them into skin cancers.

Medically Reviewed by a Doctor on 2/23/2015

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