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Most Common Precancerous Lesions

Actinic Keratosis

An actinic keratosis (AK) is a slow growing, crusty, scaly growth that if left alone could potentially develop into skin cancer (usually squamous cell carcinoma).  These are generally referred to as pre-cancers and treatment to prevent progression is recommended.  Actinic keratoses (plural of keratosis) most commonly appear on areas exposed to the sun such as face, scalp, ears, shoulders, arms and hands.  It is not uncommon to find them on the lower leg as well.

Signs and Symptoms

Actinic Keratoses can appear on the skin in different ways.  If you see any of the following, you should schedule an appointment with a dermatologist:

  • Rough, scaly crusty lesions that can appear wart-like.  They can be red, tan, white, pink and/or flesh-toned as well as a combination of these colors.
  • Often in size from an eighth to a quarter of an inch.
  • Can disappear and then reappear
  • Lesions that itch or are tender; some can become inflamed or even bleed
  • Areas of skin that feel like sandpaper without visible lesions could be indication of early AKs.


UV rays, from the sun or tanning beds, are the largest cause of AKs.  More time spent in the sun or tanning beds greatly increase your odds of developing one or more AKs.  Older people (age 50 and up) as well as  those who work outdoors are at even greater odds; however, people as young as 20 can develop AKs.  Men have a higher chance of developing AKs than women as they have the tendency to spend more time in the sun and use less sun protection.

Tanning beds can be more concentrated and more dangerous than the sun.  The more tanning you do, the higher your odds of developing AKs.

Occasionally, actinic keratoses can also be caused by extensive exposure to X-rays or a number of industrial chemicals.

Who Is Most at Risk?

People with fair skin, light (blonde or red) hair and light colored eyes (blue, green, or gray) are most vulnerable to sun damage and therefore have a higher likelihood of developing AKs and, in turn, skin cancer.

While African Americans, Hispanics, and Asians as well as others with darker skin are not as susceptible as Caucasians to develop AKs or skin cancers, everyone has the potential to do so.  It is worth noting that African Americans and Hispanics have a greater chance of finding a skin cancer in an advanced stage than Caucasians because of delayed detection.

Individuals whose immune defenses are weakened by cancer chemotherapy, AIDS, organ transplantation or other factors are less able to fight off the effects of ultraviolet radiation and thus more likely to develop actinic keratoses. You should also be aware that extensive UV exposure itself suppresses the immune system, reducing its ability to repair UV damage.

Actinic Keratoses on scalp

Treatments for Actinic Keratosis

Early treatment can eliminate almost all actinic keratoses before they become skin cancers.  Possible treatments are as follows:

  • Cryosurgery – Also called cryotherapy.  Cryosurgery uses extreme cold to destroy skin lesions.  Liquid nitrogen, which is kept around -300⁰ F, is used to instantly kill skin cells.  This is usually used when there are 15 or fewer lesions.
  • Topical treatments – Use of topical chemotherapy or immunotherapy creams can treat large areas that cannot realistically be treated with cryosurgery.

Prevention is the best medicine

Preventing sun burns and taking precautions when exposed to UV rays are the best ways to combat AKs and skin cancer.  Here are some tips to help:

  • Avoid sun exposure or seek shade between 10 AM and 4 PM.
  • Do not intentionally burn.
  • Avoid sun tanning and UV tanning beds.
  • Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
  • Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
  • Apply sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.
  • Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
  • Examine your skin head-to-toe every month.
  • See your physician every year for a professional skin exam.
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