Actinic keratosis

Last reviewed: 25 Apr 2022
Last updated: 17 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • single or multiple scaly macules or plaques
  • scaly lesions with a hyperkeratotic surface
  • well-defined, scaly, brown lesions
  • lesions resembling seborrheic keratosis, melanocytic nevus, 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-colored, papillomatous, elevated wartlike papules
  • plaques with very mild scale over very thin shiny skin
  • violaceous well-defined papules with fine white lines on the surface
More key diagnostic factors

Other diagnostic factors

  • evidence of sun damage to skin
  • pruritus or bleeding
Other diagnostic factors

Risk factors

  • chronic exposure to UVB radiation
  • light-colored skin, freckling, and albinism
  • age >40 years
  • male sex
  • immunocompromise
  • xeroderma pigmentosum
More risk factors

Diagnostic investigations

Investigations to consider

  • dermoscopy
  • skin biopsy
More investigations to consider

Treatment algorithm

ONGOING

confluent scalp lesions

head and face lesions, excluding periorbital, actinic cheilitis, and confluent scalp lesions

periorbital

persistent or severe actinic cheilitis

back of hands

below the knee

Contributors

Authors

Brian Berman, MD, PhD
Brian Berman

Professor Emeritus of Dermatology and Cutaneous Surgery

University of Miami Miller School of Medicine

Miami

Skin & Cancer Associates, LLP

Co-Director

Center for Clinical and Cosmetic Research

Aventura

FL

Disclosures

BB has acted as a consultant for Sirnaomics, Pierre Fabre, Pfizer, Lemonex, Novan, Sonoma Pharmaceuticals (with stock options), Sensus, Encore Dermatology, AiViva, Clark Pharmaceutical, Tigercat Pharmaceuticals, Menlo Therapeutics, BMS, Pulse, Almirall, Mediwound, and PHD Biosciences. BB is on the advisory board for Cutanea, Birch BioMed, Ortho Dermatologics/Valeant, TopMD, Novartis, and Smith & Nephew, and has also been a speaker for Novartis.

Sadegh Amini, MD
Sadegh Amini

Dermatologist

Skin and Cancer Associates

Voluntary Assistant Professor

Department of Dermatology and Cutaneous Surgery

University of Miami

Miller School of Medicine

Miami

FL

Disclosures

SA declares that he owns stock in AbbVie Inc.

Peer reviewers

David S. Cassarino, MD, PhD

Assistant Professor

Departments of Pathology and Dermatology

UCLA

Los Angeles

CA

Disclosures

DSC declares that he has no competing interests.

Christopher Shea, MD

Dermatopathology Fellowship Director

University of Chicago

Section of Dermatology

Chicago

IL

Disclosures

CS declares that he has no competing interests.

  • Actinic keratosis images
  • Differentials

    • Squamous cell carcinoma (SCC) in situ (Bowen disease)
    • Invasive SCC
    • Keratoacanthoma
    More Differentials
  • Guidelines

    • Guidelines of care for the management of actinic keratosis
    • Guidelines for the care of patients with actinic keratosis
    More Guidelines
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