An actinic keratosis, also called a solar keratosis, is a rough, scaly patch caused by years of ultraviolet (UV) exposure from the sun or tanning beds. UV rays damage the DNA in skin cells, causing them to grow abnormally. AKs are considered precancerous because they can progress to squamous cell carcinoma. Many squamous cell carcinomas begin as an actinic keratosis.

South Florida has strong sun all year long, not just in summer. Daily sun exposure adds up from walking the dog, driving with your window down, sitting outside at lunch, or spending weekends on the water. Over time, that damage appears as actinic keratoses, often in people in their 40s or even younger.

Actinic keratoses are often easier to feel than to see. Many patients describe running a finger over a spot that feels like sandpaper.

Common signs include:

• A rough, dry or scaly patch, usually smaller than a pencil eraser.
• A flat or slightly raised spot that may be pink, red, tan or skin-colored.
• A spot that flakes, peels, and comes back in the same place.
• Itching, burning, stinging or tenderness.
• A hard, horn-like growth sticking out from the skin.
• Dry, cracked, scaly lips that do not heal, called actinic cheilitis.

They appear on areas that get the most sun, including the face, nose, ears, scalp, lips, neck, forearms and backs of the hands. Men with thinning hair often develop them on the scalp.

• People over age 40 with years of sun exposure.
• Fair skin, light eyes and light or red hair, though anyone can develop AKs.
• A history of sunburns or tanning bed use.
• People who work or play outdoors.
• A personal history of skin cancer.
• A weakened immune system, including organ transplant recipients.

Treatment depends on how many spots you have, where they are, and your lifestyle. Your dermatologist may treat individual spots or the entire sun-damaged area, since more AKs are often forming under the surface.

Treating individual spots

• Liquid nitrogen freezes the spot, which then peels off over one to two weeks. It is quick and done during your visit.
• The spot is gently scraped away. This may be used for thicker spots, and a biopsy may be taken at the same time.

Treating the whole area (field treatment)

• Prescription creams. Topical medications applied at home for a set period treat both visible and hidden AKs. Options include 5-fluorouracil (5-FU), used alone or combined with calcipotriene, tirbanibulin (Klisyri) and imiquimod.
• Chemical peels. Medical-grade peels remove damaged surface skin and improve texture and tone.
• Laser resurfacing. Lasers such as the Fraxel Dual can treat sun damage and precancerous changes while also improving brown spots, fine lines and texture.
• Photodynamic therapy (PDT). A light-sensitizing solution is applied to the skin and activated with blue or red light to treat widespread sun damage.

What if a spot turns out to be skin cancer?

If a spot looks suspicious, a quick in-office biopsy will confirm the diagnosis. If it is skin cancer, you are already in the right place. Our providers diagnose and treat skin cancer every day, and when Mohs surgery is the treatment of choice, Dr. Shagalov, a board-certified and fellowship-trained Mohs surgeon, performs it right here. Mohs surgery offers the highest cure rate with the smallest scar.

Yes. Daily sun protection is the best way to prevent new AKs and lower your skin cancer risk.

• Wear a broad-spectrum sunscreen with SPF 30 or higher every day and reapply every two hours outdoors.
• Wear a wide-brimmed hat and UV-protective sunglasses.
• Seek shade between 10 a.m. and 4 p.m., when Miami sun is strongest.
• Never use tanning beds.
• Check your skin every month and schedule a yearly skin cancer screening.

Learn more on our Skin Cancer Prevention page.