Actinic Keratosis

Actinic keratosis (also called solar keratosis, sun spots or AK) is a pre-cancerous condition of thick, scaly or crusty patches of skin (actinic – caused by sunlight; keratosis – thickened scaly growth).  AK is common in fair-skinned people and caused by long-term sun exposure.  AKs may progress to invasive squamous cell carcinomas (SCC) and are by far the most common lesion with malignant potential to arise on the skin.  In the United States, AK represents the second most frequent reason for patients to visit a dermatologist.  The frequency of AKs is directly related to sun exposure and skin type.  AK can occur in patients as young as 20 or 30 years of age in areas of high sun exposure but is more common in patients aged 50 years and older.

AKs are typically found in areas that are exposed to the sun, such as the face, ears, bald scalp, forearms and backs of hands.  Lesions begin as barely perceivable rough spots of skin that feel like sandpaper.  Later lesions become erythematous, scaly plaques that may enlarge to several centimeters.  They can remain unchanged for years or progress to invasive SCC.  Invasive SCCs may produce significant morbidity by direct extension into facial structures.  If SCCs metastasize (in less than 10% of cases) the 5-year survival rate is low.

The fate of any one AK is impossible to predict and treatment is absolutely necessary.  Treatment today consists of surgical and/or medical therapy.  Surgical therapy is suited for localized lesions and usually results in complete removal.  However, this treatment generally leaves a scar, causing a major treatment challenge in patients with widespread AK.  Medical treatments that are currently available are slow and associated with significant irritation and discomfort. 

For additional information on AK visit the Skin Cancer Foundation (www.skincancer.org).