Chronic keratotic lesions on adult skin that has been chronically exposed to ultraviolet rays.
Has the potential to progress into an invasive squamous cell carcinoma (SCC).
Although diagnosed clinically, a biopsy may help to rule out SCC.
Treatment consists of destructive methods (e.g., cryotherapy with liquid nitrogen, curettage with or without electrodesiccation, chemical peels, and photodynamic therapy) or topical medication (e.g., topical fluorouracil, imiquimod, diclofenac, or tirbanibulin).
Actinic keratosis (AK) lesions are skin-coloured, yellowish, or erythematous, ill-defined, irregularly shaped, small, scaly macules or plaques localised in sun-exposed areas of the body. Typically, they occur in middle-aged or older men with light-coloured skin and a history of chronic sun exposure. They can potentially progress into squamous cell carcinoma (SCC).
History and exam
Key diagnostic factors
- presence of risk factors
- single or multiple scaly macules or plaques
- scaly lesions with a hyperkeratotic surface
- well-defined, scaly, brown lesions
- lesions resembling seborrhoeic keratosis, melanocytic naevus, and early malignant melanoma
- hypertrophic conical-shaped protuberances growing from the surface of the skin
- scaly red roughness with induration, fissuring, and ulceration of the lower lip to the commissures
- lesion on sun-exposed area of body
- skin-coloured, papillomatous, elevated wart-like papules
- plaques with very mild scale over very thin shiny skin
- violaceous well-defined papules with fine white lines on the surface
Other diagnostic factors
- evidence of sun damage to skin
- pruritus or bleeding
- chronic exposure to UVB radiation
- light-coloured skin, freckling, and albinism
- age >40 years
- male sex
- xeroderma pigmentosum
Investigations to consider
- skin biopsy
confluent scalp lesions
head and face lesions, excluding periorbital, actinic cheilitis, and confluent scalp lesions
persistent or severe actinic cheilitis
back of hands
below the knee
Brian Berman, MD, PhD
Professor Emeritus of Dermatology and Cutaneous Surgery
University of Miami Miller School of Medicine
Skin & Cancer Associates, LLP
Center for Clinical and Cosmetic Research
BB is, or has been, a paid consultant/advisor for Almirall (manufacturer of tirbanibulin), TopMD, Lemonex, Berg Pharma, Novartis, Aiviva, Ferndale, Sensus, Novan, Klara, Pierre Fabre (manufacturer of 5-FU), Biofrontera (manufacturer of ALA), SUN (manufacturer of ALA), LEO (manufacturer of ingenol mebutate), Pulse, Sirnaomics, Menlo, Sonoma, PHD Biosciences, Birch BioMed, Mediwound, Mino Labs. He has been a speaker for Almirall (manufacturer of tirbanibulin), LEO (manufacturer of ingenol mebutate), Sensus. His institution has received investigator funding from Biofrontera (manufacturer of ALA), LEO (manufacturer of ingenol mebutate), Pulse, Sirnaomics, Menlo, Birch BioMed, Mediwound.
Sadegh Amini, MD
Skin and Cancer Associates
Voluntary Assistant Professor
Department of Dermatology and Cutaneous Surgery
University of Miami
Miller School of Medicine
SA declares that he owns stock in AbbVie Inc.
David S. Cassarino, MD, PhD
Departments of Pathology and Dermatology
DSC declares that he has no competing interests.
Christopher Shea, MD
Dermatopathology Fellowship Director
University of Chicago
Section of Dermatology
CS declares that he has no competing interests.
- Squamous cell carcinoma (SCC) in situ (Bowen's disease)
- Invasive SCC
- Focused update: guidelines of care for the management of actinic keratosis
- Guidelines of care for the management of actinic keratosis
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer