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Actinic Keratosis

Precancerous Skin Lesion, Solar Keratosis

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Facts

Actinic keratosis (AK) is a lesion that forms on sun-damaged skin. The lesions are small scaly patches on parts of the body, such as the face, ears, bald scalp, arms, and hands, which have been chronically exposed to the sun.

AK is a precancerous condition that affects only the top layer of skin (the epidermis). Ultraviolet (UV) rays from the sun damages the skin and if left untreated, 15% of AK can turn into a form of skin cancer called squamous cell carcinoma (SCC). This percentage increases significantly in people who have more than 5 AK lesions. When they are found early, AKs are highly treatable.

AK is more common in people with fair skin.  About 60% of all Canadians over the age of 40 have at least one AK lesion. Australia has the highest rate of AK in the world.

Causes

UV light from the sun and commercial tanning lamps or beds are the major causes of AK. UV light causes changes in the genetic material of the skin’s cells. Changes in certain genes can cause cells to grow abnormally and form lesions.

Risk factors include:

  • age 40 and older – AK can happen at any age, but the risk increases with accumulated sun exposure
  • immunosuppression – the body’s ability to recognize and fight abnormal cells are lowered in people with weak immune systems (e.g., as a result of taking organ transplant medications or chemotherapy, or having AIDS), so cells with gene changes are allowed to grow and form lesions
  • people with fair skin – also people who have red or blonde hair and those who tend to burn rather than tan develop AK more easily
  • sun exposure – people who work outdoors or have more exposure to the sun are at higher risk

Treatment and Prevention

There are several options available for treating AK. Which one is best will depend on factors such as the size and location of the lesions, the number of lesions, and the person’s overall health.

Cryotherapy uses a very cold substance, like liquid nitrogen, to freeze and kill the skin cells that make up the AK lesion. The liquid nitrogen is applied as a spray or with a swab. This treatment method is best for a small number of lesions. Topical medications (see below) may be used prior to cryotherapy to improve results.

Excision is surgical removal of the lesion using a sharp blade.

Electrodessication and curettage dries out the AK cells with an electric current and then scrapes them out using a curette (a sharp instrument). These procedures require a local anesthetic. Like cryotherapy, these are not practical for large numbers of lesions.

Topical medications (medications that are applied to the skin) can be used to treat actinic keratoses and superficial basal cell carcinoma (sBCC). Topical medications include 5-fluorouracil* (also known as fluorouracil or 5-FU) and imiquimod.

  • 5-FU belongs to the group of medications known as topical antineoplastics. It works by interfering with cancer cell growth. It is applied to the skin in a thin layer and is then covered. The treatment is repeated daily over several weeks. This method is good for treating large areas of skin. Women who are pregnant should not use 5-FU.
  • Imiquimod is another topical medication for the treatment of AK. It belongs to a group of medications called immune response modifiers. This type of medication works by stimulating the immune system to produce substances that fight against the cancer. The treatment is applied to the skin twice a week for 16 weeks. This method is good for treating larger areas of skin.

Photodynamic therapy (PDT) uses light and a light-sensitizing medication to kill AK skin cells. The medication is applied to the skin and is absorbed by the abnormal AK cells more than the normal surrounding cells. The skin is then exposed to a specific colour of light that activates the medication and kills the cells. PDT is good for treating large areas of skin with many AK lesions.

Other possible treatments include:

  • chemical peels
  • dermabrasion
  • laser treatment
  • other topical medications (e.g., diclofenac)

The best way to prevent AK is to avoid overexposure to the sun. Use a sunscreen with a sun protection factor (SPF) of at least 30, applied one-half hour before sun exposure and reapply every 2 hours. Wear a hat and protective clothing to help protect your skin from the sun’s UV rays. Remember to protect children as well. Try to stay out of the sun during peak hours (11 am to 4 pm). It’s important to make sure your sunscreen protects against both UVA and UVB rays.

All material copyright MediResource Inc. 1996 – 2025. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Actinic-Keratosis

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