What Is Actinic Keratosis?
Actinic keratosis (AK), also called solar keratosis, is a rough, scaly patch of skin caused by years of ultraviolet (UV) exposure from the sun or tanning beds. It is a precancerous growth. Most AKs never become cancer, but some develop into squamous cell carcinoma, a common type of skin cancer.
AKs usually appear on sun-exposed skin, such as the face, ears, balding scalp, lips, neck, forearms and backs of the hands. They are among the most common conditions dermatologists treat. The American Academy of Dermatology estimates that more than 40 million Americans develop actinic keratoses each year.
An AK can look like other skin spots, including early skin cancer. Have a clinician check any rough or scaly patch that doesn't heal.
Actinic Keratosis at a Glance
| Also called | Solar keratosis. On the lip, it is called actinic cheilitis. |
|---|---|
| Cause | Years of UV damage from the sun or indoor tanning |
| Where it appears | Face, ears, balding scalp, lips, neck, forearms and backs of the hands |
| Is it cancer? | No. It is precancerous, and some AKs become squamous cell carcinoma. |
| Diagnosis | A skin exam. A biopsy if a spot looks suspicious or doesn't respond to treatment. |
| Treatment | Freezing (cryotherapy), prescription creams, photodynamic therapy, curettage or a medical-grade chemical peel |
| Contagious? | No |
| ICD-10 code | L57.0 |
What Does Actinic Keratosis Look and Feel Like?
AKs are often easier to feel than to see. Common signs include:
- Texture: a rough, dry, sandpaper-like patch
- Color: pink, red, tan, white, gray or the same color as your skin
- Shape: flat or slightly raised. Some grow into a hard, horn-like bump, which raises the risk of skin cancer.
- Sensation: it may itch, burn, sting, feel tender or bleed
- On the lip: a dry, scaly lip that doesn't heal, or heals and comes back (actinic cheilitis)
Many people have more than one AK. Having one is a sign that the surrounding skin has sun damage and that more AKs are likely to develop.
What Causes Actinic Keratosis?
UV radiation damages the DNA in keratinocytes, the cells that make up the outer layer of skin. Over many years, damaged cells can grow abnormally and form the rough patches of an AK. Because the damage builds up over a lifetime, AKs are most common in people 50 and older. People who used tanning beds or live in a warm, sunny place can get them in their 20s.
Sun exposure adds up quickly in Georgia. In 2025, NOAA's forecast UV index for Atlanta reached the "very high" or "extreme" range on 108 days, mostly from April through September.
You may be at higher risk if you have:
- Fair skin that burns easily and rarely tans
- Red or blond hair, or light-colored eyes
- Spent a lot of time outdoors without sun protection
- Used tanning beds
- A weakened immune system, including after an organ transplant
Can Actinic Keratosis Turn Into Skin Cancer?
Yes, some can, which is why AKs are considered precancerous. Most individual AKs do not become cancer, and some fade on their own. However, they often come back, and new ones tend to form on the same sun-damaged skin.
- A study of high-risk veterans followed more than 7,000 AKs. It found that the chance of a single AK becoming squamous cell carcinoma was about 0.6% at one year and 2.6% at four years.
- The same study found that about 65% of the squamous cell carcinomas that developed came from spots previously diagnosed as AKs.
- Risk is higher for people with many AKs and for people with a weakened immune system.
See a clinician promptly if an AK grows quickly, becomes hard or thick, bleeds, turns into an open sore, becomes painful, or doesn't go away with treatment. These can be signs that it has become squamous cell carcinoma, and a biopsy is needed to check.
Actinic Keratosis vs. Other Skin Spots
| What it is | Look and feel | Treatment needed? | |
|---|---|---|---|
| Actinic keratosis | Precancerous growth caused by UV damage | Rough, dry and scaly. Often easier to feel than see. | Usually recommended |
| Seborrheic keratosis | Harmless growth, most common in middle age and later | Waxy, like a dab of candle wax. Usually tan or brown. | Usually not. It can be removed if it gets irritated or catches on clothing. |
| Squamous cell carcinoma | Skin cancer. Some start as an AK. | A firm bump, rough scaly patch, or sore that bleeds or doesn't heal | Yes, promptly |
| Age spot (solar lentigo) | Harmless sun spot | Flat and painless. Light brown to black. | No. Removal is cosmetic. |
Spots like these can look alike. Only a clinician can reliably tell them apart.
How Is Actinic Keratosis Diagnosed?
Most AKs are diagnosed by looking carefully at the skin. A lighted magnifier called a dermatoscope can help tell an AK apart from other spots. A biopsy is needed when a spot is larger than about 1 cm (⅜ inch), bleeds, is open or hard, grows quickly, or doesn't respond to treatment, to check for squamous cell carcinoma.
How Is Actinic Keratosis Treated?
Treatment depends on how many AKs you have, where they are and your overall health. The American Academy of Dermatology's 2021 guidelines strongly recommend UV protection, imiquimod, 5-fluorouracil and cryosurgery, and conditionally recommend photodynamic therapy and diclofenac. There are two broad approaches.
Treating Individual Spots
These treatments are usually done in one or two office visits:
- Cryotherapy: liquid nitrogen freezes the AK, which falls off within a few days.
- Curettage: the AK is scraped away, sometimes followed by electrodesiccation. This is often used for thick AKs.
Treating a Whole Area of Sun-Damaged Skin
These treatments are used for multiple AKs, including ones not yet visible:
- Prescription creams and gels: 5-fluorouracil (5-FU), imiquimod, diclofenac or tirbanibulin (for the face and scalp)
- Photodynamic therapy (PDT): a light-sensitizing solution is applied, then activated with blue or red light. Most patients need two treatments about three weeks apart.
- Medical-grade chemical peels and laser resurfacing: these remove the damaged top layers of skin. Laser resurfacing is also an option for AKs on the lip.
Avoid hydrocortisone and other steroid creams on treated skin unless your provider tells you to use them. The American Academy of Dermatology notes they can stop AK treatment from working.
People with many AKs usually need follow-up skin exams, often once or twice a year, because new AKs and skin cancers are more likely on sun-damaged skin.
Can You Prevent Actinic Keratosis?
You can't undo past sun damage, but you can lower your chances of new AKs:
- Use a broad-spectrum, water-resistant sunscreen with SPF 30 or higher every day, even when it's cloudy. Reapply every two hours outdoors, and after swimming or sweating.
- Seek shade, especially between 10 a.m. and 2 p.m., when the sun's rays are strongest.
- Wear a wide-brimmed hat, sun-protective clothing and sunglasses with UV protection.
- Avoid tanning beds.
- Check your skin regularly and see a clinician about new or changing spots.
When Should You See a Clinician About Actinic Keratosis?
Make an appointment if you notice:
- A rough or scaly patch on sun-exposed skin
- A spot that bleeds, grows quickly, becomes hard or painful, or turns into an open sore
- A horn-like growth
- A dry, scaly lip that doesn't heal or keeps coming back
- A spot that doesn't clear with treatment
- Many rough spots on sun-damaged skin, or any new spot if you have a weakened immune system
Actinic Keratosis Evaluation at GENEVA
At GENEVA Primary Care & Med Spa in Alpharetta, GA, a primary care provider can examine a rough or changing spot and review your sun exposure and skin cancer history. Based on that evaluation, your provider will recommend whether the spot can be treated at GENEVA or whether you should see a dermatologist.
You can raise a skin concern during a primary care visit or an annual physical exam. GENEVA serves patients from Alpharetta, Johns Creek, Milton, Roswell and Cumming.
Related Terms
- Aging skin
- Retinoid therapy
- TCA peel
- Medical-grade skincare
- Preventive screening
- Xerosis (dry skin)
- VI Peel Treatment | Benefits, Results and What to Expect
Actinic Keratosis FAQs
Is actinic keratosis cancer?
No. Actinic keratosis is a precancerous skin growth, not skin cancer, but some actinic keratoses turn into squamous cell carcinoma. In a study of high-risk veterans that followed more than 7,000 actinic keratoses, the chance of a single one becoming squamous cell carcinoma was about 0.6% at one year and 2.6% at four years. About 65% of the squamous cell carcinomas in that study started in spots already diagnosed as actinic keratoses. A spot that grows, bleeds, hardens or won't heal should be checked, and sometimes biopsied.
Can actinic keratosis go away on its own?
Sometimes, but actinic keratoses often come back, and new ones tend to form on the same sun-damaged skin. A systematic review found that 15% to 63% of individual actinic keratoses faded within a year without treatment, yet 15% to 53% of those that faded returned within a year. Because some actinic keratoses become skin cancer, clinicians usually recommend treating them or checking them regularly rather than waiting. People with many actinic keratoses often need follow-up exams once or twice a year.
What does actinic keratosis look like?
Actinic keratosis usually looks like a small, rough, scaly patch on skin that has had a lot of sun, and it is often easier to feel than to see. The patch can be pink, red, gray, tan, white or the same color as your skin, and some look like a pimple, an age spot or a patch of irritated skin. Actinic keratoses appear most often on the face, ears, balding scalp, lips, neck, forearms and backs of the hands. They can itch, burn, sting or bleed. A thick, horn-like growth needs a prompt exam, because it can signal a higher risk of skin cancer.
What is the difference between actinic keratosis and seborrheic keratosis?
Actinic keratosis is a rough, scaly, precancerous patch caused by sun damage, while seborrheic keratosis is a harmless skin growth. Seborrheic keratoses often look like a dab of candle wax or have a warty surface, range from white to black (most are tan or brown) and usually appear in middle age or later, anywhere except the palms and soles. Actinic keratoses feel rough like sandpaper and appear on sun-exposed skin. Seborrheic keratoses most often need no treatment, while actinic keratoses usually do. A clinician can tell them apart during a skin exam.
How is actinic keratosis treated?
Actinic keratosis is treated either spot by spot in the office or across a whole area of sun-damaged skin, depending on how many you have and where they are. The American Academy of Dermatology's 2021 guidelines strongly recommend cryosurgery (freezing), 5-fluorouracil cream, imiquimod cream and UV protection, and conditionally recommend photodynamic therapy and diclofenac gel. Thick spots may be scraped off with curettage, and medical-grade chemical peels are another option. Field treatments such as 5-fluorouracil, typically used for 2 to 4 weeks, also treat spots that aren't visible yet. Avoid hydrocortisone on treated skin unless your provider says otherwise.
Who is most likely to get actinic keratosis?
Actinic keratosis is most common in people 50 and older who have spent a lot of time outdoors without sun protection, especially those with fair skin that burns easily and rarely tans, red or blond hair, or light-colored eyes. People who used tanning beds or live in a warm, sunny place can get actinic keratoses in their 20s. A weakened immune system also raises the risk, and organ transplant recipients tend to develop many. Having one actinic keratosis is a sign of sun damage, so more are likely to appear. The American Academy of Dermatology estimates that more than 40 million Americans develop actinic keratoses each year.
Can a primary care provider diagnose actinic keratosis?
Yes. Actinic keratosis is usually diagnosed by examining the skin, so a primary care provider can often recognize it during a regular visit or an annual physical. At GENEVA in Alpharetta, your provider examines the spot, reviews your sun exposure and skin cancer history, and then recommends either treatment at GENEVA or a referral to a dermatologist. A spot that is larger than about 1 cm (3/8 inch), bleeding, open, hard, growing quickly or not responding to treatment may need a biopsy to rule out squamous cell carcinoma.
How can I prevent actinic keratosis?
You can't undo past sun damage, but daily sun protection lowers your chances of new actinic keratoses. The American Academy of Dermatology recommends a broad-spectrum, water-resistant sunscreen with SPF 30 or higher, reapplied every two hours outdoors and after swimming or sweating, and shade when the sun's rays are strongest, between 10 a.m. and 2 p.m. Wear a wide-brimmed hat, sun-protective clothing and sunglasses with UV protection, and avoid tanning beds. Check your skin regularly and see a clinician about any new or changing spot, especially one that feels rough or scaly.