Actinic keratoses (AKs), also known as solar keratoses, are precancerous rough, scaly patches of skin caused by long-term exposure to ultraviolet (UV) radiation. While most remain harmless, some can develop into squamous cell carcinoma (SCC) over time.
Actinic keratoses (AKs) are areas of abnormal skin growth caused by years of sun exposure. They develop when ultraviolet radiation damages the DNA within skin cells, leading to changes in the outer layer of the skin (the epidermis).
Actinic keratoses often appear as rough, dry or scaly patches that may be easier to feel than see. They are usually harmless but are considered precancerous because some can progress to squamous cell carcinoma if left untreated.
IMPORTANT: Actinic keratoses can vary in appearance and may not always look like the image shown. Lesions are often rough, scaly patches but can differ in size, colour and texture. Images are for illustrative purposes only and should not be used for self-diagnosis.
Actinic keratoses are among the most common skin conditions seen in dermatology clinics. They become increasingly common with age due to the cumulative effects of sun exposure over many years. Studies suggest they affect a significant proportion of adults over the age of 60 in the UK.
Anyone can develop actinic keratoses, but they are more common in people who:
Actinic keratoses develop most often on areas that receive regular sun exposure, including:
A related condition known as actinic cheilitis affects the lips, most commonly the lower lip.
People with multiple actinic keratoses often have wider areas of sun-damaged skin known as field cancerisation. This means that skin surrounding visible lesions may also contain microscopic UV-induced changes, increasing the likelihood of developing additional actinic keratoses or skin cancers in the future.
Actinic keratoses can vary in appearance but commonly present as:
Many people notice the rough texture before they notice any visible change in the skin.
Most actinic keratoses do not become cancerous. However, because it is impossible to predict which lesions may progress, they should be monitored and assessed when appropriate.
Signs that may suggest progression towards squamous cell carcinoma include:
Any of these changes should be assessed promptly by a healthcare professional.
The primary cause is cumulative exposure to ultraviolet radiation from sunlight.
Over time, UV radiation damages DNA within skin cells. When this damage accumulates faster than the skin can repair it, abnormal cells can develop and form actinic keratoses.
Artificial UV sources such as sunbeds and tanning devices can also contribute to their development.
Diagnosis is usually made by a GP or dermatologist based on the appearance, texture and location of the lesions during a clinical skin examination. Actinic keratoses often have a characteristic rough, sandpaper-like feel that makes them easier to identify by touch than by sight alone.
A dermatoscope, a hand-held magnifying tool, may be used to view the skin more closely.
Yes. Clinicians frequently use dermoscopy, a specialised magnifying device that allows closer examination of skin structures and can improve diagnostic accuracy.
If a lesion looks unusual, grows quickly, bleeds, crusts, or has features suggestive of skin cancer, a small sample of skin (biopsy) may be taken and examined in a laboratory to rule out squamous cell carcinoma or other skin cancers.
Not necessarily.
Some actinic keratoses may be monitored rather than treated, particularly if they are small, stable and causing no symptoms. Treatment decisions depend on the number of lesions, their appearance, associated symptoms and an individual’s overall skin cancer risk.
Treatment aims to remove abnormal cells, improve symptoms and manage areas of sun-damaged skin that may be at risk of further change.
Treatment options may include:
The most appropriate treatment depends on the number, thickness and location of the lesions, as well as individual circumstances.
Yes. Individual lesions can often be treated successfully, but new lesions may develop over time because the underlying sun damage remains.
People who have developed actinic keratoses are more likely to develop additional lesions in the future and may benefit from ongoing skin monitoring.
Actinic keratoses do not usually go away on their own and may persist or recur without treatment. Treatment often clears lesions and can reduce the risk of progression to skin cancer, but there is a possibility that new lesions may develop over time, particularly in areas exposed to sunlight.
Yes. A small proportion of actinic keratoses can develop into invasive squamous cell carcinoma over time.
The risk is higher in people with multiple lesions, extensive sun damage or a weakened immune system. For this reason, regular skin checks and prompt assessment of suspicious changes are important.
It may not be possible to prevent all actinic keratoses, but protecting the skin from UV radiation can significantly reduce the risk.
Helpful measures include:
Good sun protection can help reduce the development of new actinic keratoses and lower the risk of skin cancer.
Arrange a skin assessment if you notice:
Early assessment can help distinguish actinic keratoses from skin cancer and ensure appropriate treatment where needed.
If you have a persistent patch of sun-damaged skin that feels rough, scaly or continues to change, arranging a professional skin assessment can help identify actinic keratoses and determine whether treatment or monitoring is appropriate.
