Actinic Keratoses

An actinic keratosis is an area where skin cells have been altered by UV damage. Sunlight penetrates the skin and affects the DNA inside cells. Over time, repeated exposure disrupts normal growth patterns, leading to patches that differ in texture and appearance from surrounding skin.

These areas are typically found on parts of the body that receive regular sun exposure, including the face, ears, scalp, neck, chest, forearms, and the backs of the hands. In individuals with thinning hair or baldness, the scalp is particularly vulnerable.

Many patients first notice a small, rough spot that feels dry or gritty. The surface may be easier to detect by touch than by sight. Some remain flat and subtle, while others thicken and become more noticeable.

The primary cause is cumulative ultraviolet radiation. This includes both natural sunlight and artificial UV exposure from tanning beds. The damage builds gradually over years, often beginning in childhood and continuing through adulthood.

Several factors increase risk:

• Chronic outdoor work or recreation
• Living in sunny climates
• Repeated sunburns
• Use of tanning devices
• A weakened immune system

Individuals who are immunosuppressed, such as organ transplant recipients, often develop a greater number of lesions and may face a higher chance of progression to invasive skin cancer.

Actinic keratoses vary in color and texture. They may look pink, red, tan, or skin-colored. The surface often appears dry, scaly, or slightly raised. In some cases, a thicker, crusted layer forms. Certain lesions develop a hardened projection that resembles a small horn.

Symptoms are usually mild. Some areas may feel tender, sensitive, or mildly itchy. Others cause no discomfort at all. On the lips, chronic sun damage can cause persistent dryness, cracking, or discoloration, a related condition known as actinic cheilitis.

Clusters are common, particularly on the forehead, temples, and scalp. Any lesion that begins to enlarge quickly, bleed, form an open sore, or become increasingly painful should be evaluated promptly, as these changes may indicate transformation into squamous cell carcinoma.

Although not every actinic keratosis becomes cancerous, a portion will progress over time. Because there is no reliable way to predict which one will advance, treatment is typically recommended.

Diagnosis begins with a detailed skin examination by an experienced board-certified dermatologist like Dr. Richey. If a lesion appears thicker than expected, ulcerated, inflamed, or otherwise atypical, a biopsy may be performed but is typically not required for this diagnosis.

A biopsy involves removing a small sample of tissue under local anesthesia. The specimen is examined under a microscope to determine whether cancerous changes are present. This procedure is brief and provides critical diagnostic information.

Actinic keratoses are common, particularly in individuals with decades of sun exposure. However, they should not be dismissed as harmless age-related changes. Early identification and management reduce the likelihood of invasive skin cancer.