If you have spent years in the sun, you may have noticed small, rough patches on your face, scalp, ears, forearms or the backs of your hands. They can feel like sandpaper, come and go, and sometimes flake off before returning. These are very often actinic keratoses, one of the most common reasons people see a dermatologist in Florida.
Actinic keratoses are not skin cancer, but they are considered precancers. Here is what that means, and how we treat them at our Palm Beach Gardens office.
Key takeaways
- Actinic keratoses (AKs) are rough, scaly spots caused by years of sun damage.
- They are precancers. A small share can turn into squamous cell carcinoma over time.
- People who have one usually have many, including some that are not visible yet.
- Treatment options include freezing, prescription creams and removal of suspicious spots.
- Regular skin checks and daily sun protection are the best long-term plan.
What are actinic keratoses?
Actinic keratoses are areas of skin where sun damage has changed the cells in the top layer. They usually appear on the parts of the body that get the most sun: the face, bald scalp, ears, lips, neck, forearms and hands.
They often look like:
- Rough, dry, scaly patches, sometimes easier to feel than to see
- Pink, red or skin-colored spots, usually a few millimeters to a centimeter across
- Spots that flake, crust and then come back
- Sometimes tender or itchy spots
When they appear on the lower lip, they are called actinic cheilitis, which can make the lip look dry, scaly or blurred at the edge.
Why they are so common in Florida
The main cause is cumulative sun exposure. The more years of sun your skin has had, the more likely you are to develop AKs. That is why they are so common in South Florida, where the sun is strong most of the year, and among people who have spent a lifetime outdoors golfing, boating, fishing or at the beach.
Other risk factors include fair skin, light eyes and hair, a history of sunburns, older age, and a weakened immune system, such as after an organ transplant.
How actinic keratoses relate to skin cancer
Most actinic keratoses never become cancer, and some even go away on their own. But a small percentage can progress to squamous cell carcinoma, a common and very treatable type of skin cancer. Since it is hard to predict which ones will change, dermatologists usually recommend treating them.
Having AKs is also a sign of significant sun damage, which means a higher chance of developing other skin cancers. That is why they are a good reason to have a full-body skin check on a regular schedule. You can read more about basal and squamous cell carcinoma on our site.
How we treat actinic keratoses
The right treatment depends on how many spots you have, where they are, and your preferences. Many people use more than one approach over time.
Freezing (cryotherapy)
Freezing with liquid nitrogen is the most common treatment for individual spots. It takes seconds per spot and is done during a regular office visit. The treated area turns red, may blister, and then heals over one to two weeks, usually leaving normal-looking skin.
Prescription creams for larger areas
When there are many spots, or the whole face or scalp shows sun damage, a prescription cream can treat the entire area, including early spots you cannot see yet. This is called field treatment. Our page on topical treatment for precancers explains the options.
Creams cause redness, scaling and some irritation during treatment, which is a sign they are working. The course usually lasts a few weeks. Many people prefer to do it at a time with fewer social plans.
Biopsy or removal for suspicious spots
If a spot is thick, growing, painful or bleeding, it may not be a simple AK. In that case your provider may recommend a biopsy to check for skin cancer before deciding on treatment.
After treatment: preventing new spots
Treatment clears existing spots, but the sun damage underneath remains. New AKs can keep appearing, so prevention matters:
- Use a broad-spectrum sunscreen with SPF 30 or higher every day, even on cloudy or cool days
- Reapply every two hours outdoors
- Wear a wide-brimmed hat, sunglasses and UPF clothing
- Seek shade between late morning and mid-afternoon
- Use an SPF lip balm
- Keep up with regular skin checks
Daily sunscreen use has been shown to reduce new AKs over time, even in people who already have a lot of sun damage.
When to see a dermatologist
Book a visit if you notice:
- A rough spot that keeps coming back
- A new spot on your face, scalp, ears or hands that will not heal
- A spot that is growing, thickening, painful or bleeding
- Dry, scaly changes on your lower lip
Frequently asked questions
Are actinic keratoses skin cancer?
No, they are precancers. A small percentage can turn into squamous cell carcinoma, which is why we usually treat them.
Does freezing hurt?
It stings for a few seconds, then feels like a mild burn for a short time. Most people tolerate it well without numbing.
Will they come back?
Treated spots usually clear, but new ones can appear because the underlying sun damage remains. Regular checks help catch new spots early.
Is treatment covered by insurance?
Treatment of actinic keratoses is generally considered medical care. Our Palm Beach Gardens office accepts Medicare, Aetna and Cigna. See our insurance page for details.
Book a skin check in Palm Beach Gardens
If you have rough spots that keep coming back, we can help. Our Palm Beach Gardens office is at 3345 Burns Road, Suite 101, and our providers include board-certified dermatologist Dr. Mitchell Mandel. Book online or call or text (561) 567-6775.