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Actinic Keratoses

Actinic keratoses (AKs) are rough, scaly patches or lesions that develop on skin chronically exposed to ultraviolet (UV) radiation from the sun or tanning beds. These lesions are considered precancerous because they can progress into squamous cell carcinoma (SCC), a common form of skin cancer. While only a small percentage of AKs will become cancerous, individuals with multiple lesions are at significantly higher risk. Early detection and treatment are crucial for preventing progression to skin cancer.

AKs typically appear on sun-exposed areas of the body such as the face, ears, scalp (especially in balding individuals), neck, forearms, hands, chest, legs, and lips. When they form on the lower lip, the condition is referred to as actinic cheilitis, a more aggressive subtype that requires careful monitoring.

The appearance of an AK can vary widely depending on its location and the degree of sun damage. Common characteristics include:

  • Rough, dry, or scaly patches that persist or recur
  • Flat or slightly raised lesions with a pink, red, or flesh-toned appearance
  • Areas of pigment variation, sometimes with a brown, gray, or reddish background
  • Borders that are often well defined but may blend into the surrounding skin
  • On the face, a strawberry-like texture may be noted
  • AKs usually feel like sandpaper or coarse skin
  • Lesions may itch, sting, or feel tender

AKs can sometimes disappear and reappear in the same spot. If a lesion begins to enlarge, ulcerate, bleed, crust, or become tender, this raises concern for squamous cell carcinoma and warrants immediate evaluation.

AKs are most common in:

  • Individuals with fair skin, light-colored eyes, and light hair
  • People with a history of frequent or intense sun exposure, including those who have used tanning beds
  • Those with a history of sunburns, particularly during childhood
  • Adults over the age of 40, though AKs can occur earlier in people with significant UV exposure
  • People living in sunny climates or at high altitudes
  • Individuals with weakened immune systems, including transplant recipients or those on immunosuppressive medications

Dr. Brian Hibler diagnoses AKs through a clinical skin examination, often aided by dermoscopy, a non-invasive magnification tool that allows for close-up inspection of the lesion’s structure, pigment patterns, and vascular features.

If a lesion appears suspicious for skin cancer, a biopsy may be performed to confirm the diagnosis and rule out squamous cell carcinoma or another skin cancer.

Dr. Brian Hibler diagnoses AKs through a clinical skin examination, often aided by dermoscopy, a non-invasive magnification tool that allows for close-up inspection of the lesion’s structure, pigment patterns, and vascular features.

If a lesion appears suspicious for skin cancer, a biopsy may be performed to confirm the diagnosis and rule out squamous cell carcinoma or another skin cancer.

If you notice persistent rough spots or scaly patches on sun-exposed areas or have a personal history of skin cancer or extensive sun exposure, early evaluation is essential. Dr. Brian Hibler, a board-certified and Harvard fellowship-trained medical and cosmetic dermatologist in Manhattan, offers comprehensive care for actinic keratoses and sun-damaged skin. [Did you know? Laser treatments are FDA-approved for treating AKs and sun-damaged skin. LINK TO FRAXEL] A personalized treatment plan including FDA approved laser treatments can help protect your skin’s health and your future. Schedule a consultation with Dr. Brian Hibler at his Manhattan office today.

At a Glance

Dr. Brian Hibler

  • Board-certified dermatologist
  • Fellowship-trained dermatologist
  • Ivy League educated at Cornell and Harvard Medical School
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