Actinic Keratoses

AKs are often easier to feel than see. Patients commonly describe them as feeling like sandpaper, even when the lesion is subtle.

Typical features include:

• Rough, scaly, gritty, or crusted patches
• Pink, red, or skin-colored appearance
• Sensitivity or tenderness to touch
• Flat or slightly raised spots that recur after flaking off
• Multiple lesions grouped in a “field” of sun-damaged skin

Over time, untreated AKs may become thicker or more painful—signs that warrant evaluation by a dermatologist.

Actinic keratoses develop after cumulative UV exposure from both natural sunlight and tanning beds. UV radiation damages the DNA of skin cells, and over many years, these damaged cells can begin to grow abnormally. Factors that increase the risk include:

• A history of significant sun exposure
• Fair complexion, light eyes, or red/blonde hair
• Immunosuppression
• History of skin cancer
• Living in sunny climates or working outdoors

Because AKs signal UV-related skin damage, their presence indicates an increased lifetime risk of developing future skin cancers. Early diagnosis and continual monitoring are important to prevent skin cancers.

While actinic keratoses are not cancer, they are widely recognized as precancerous. A small percentage can progress to squamous cell carcinoma. Early treatment stops that progression and also helps rejuvenate aging, sun-damaged skin. For patients who develop frequent AKs, professional dermatologic care and diligent sun protection offer long-term benefits.

Dermatologists can typically diagnose AKs through a skin examination alone. Dermoscopy, a handheld tool that provides magnification and enhanced visualization, can help differentiate AKs from other conditions. Occasionally, if a lesion appears atypical or thicker than expected, a skin biopsy may be performed to rule out early squamous cell carcinoma.

At Vue Dermatology & Laser, treatment is tailored to the number of lesions, the extent of sun damage, and patient preference. Many patients benefit from a combination approach.

1. Cryotherapy (Liquid Nitrogen)

The most common treatment for isolated lesions. Liquid nitrogen freezes the damaged cells, which flake off over several days.

• Quick and effective
• Minimal downtime
• May leave temporary light or dark spots in some skin types

2. Topical Medications

Ideal for treating multiple lesions or “field therapy,” where the entire sun-damaged area is treated. Options include:

• 5-Fluorouracil (5-FU)
• Imiquimod
• Tirbanibulin

These medications stimulate the immune system or target abnormal cells. Treatment often leads to visible redness and scaling as the precancerous cells are destroyed—an expected and temporary reaction.

3. Photodynamic Therapy (PDT)

A light-based treatment where a photosensitizing medication is applied to the skin and activated by a specialized blue or red light.

• Treats widespread areas
• Effective and well-tolerated
• Offers cosmetic improvement by targeting sun damage more broadly

4. Laser Therapy

Advanced resurfacing lasers, such as fractional lasers, can help reduce field cancerization and improve texture and pigmentation changes from sun damage.

• Addresses both AKs and photoaging
• Often part of long-term maintenance in high-risk patients

5. Chemical Peels

Medium-depth peels can remove superficial precancerous lesions and improve overall skin tone.