Actinic keratosis: symptoms, treatment and skin cancer risk

The NHS says that if you only have 1 patch, a GP might suggest waiting to see if it goes away by itself. If you have more than 1 patch, or a patch is causing problems such as pain and itchiness, treatment is usually recommended, and a GP may refer you to a skin specialist (dermatologist).

BAD says some actinic keratoses may go away without treatment, especially if they are small and the skin is protected from the sun, and that moisturisers can be used for scaly patches. Treatment depends on the number and location of the patches and other factors that differ between people, and some people choose to self-monitor their skin rather than treat.

The NHS describes actinic keratoses as dry, scaly patches of skin damaged by the sun, and says they usually appear on areas often exposed to the sun, such as the face, hands and arms, ears, scalp and legs. BAD says the terms actinic and solar mean "caused by sunlight", and keratosis refers to thickened skin.

BAD says they usually occur on the forearms, back of the hands, face, ears and any scalp areas without hair, and may also occur on the lips. There are usually several in the same area of sun-exposed skin; they rarely occur alone.

According to BAD, actinic keratoses can be variable in appearance. They may simply feel rough or scaly, looking like dry skin, and are often pink but can be skin-coloured or red. A change in texture may be noticed before a colour change. They can grow to 1 to 2cm in diameter and occasionally develop a thicker lumpy layer, and the surrounding skin often looks sun-damaged (blotchy, freckled and wrinkled).

BAD says they often do not cause any trouble but can be itchy or sore.

• Dry, rough, scaly patches that can feel like sandpaper.

• Patches 1cm to 2cm in size, skin-coloured, pink, red or brown.

• Often on the face, hands, forearms, ears, scalp or lips.

• Sometimes itchy or sore; often no symptoms.

BAD says actinic keratoses are caused by sun exposure over many years, including sunbathing, sunbed use, outdoor work or recreational activities, and living in a country with a sunny climate. Phototherapy or ionising radiation may also contribute.

They occur more commonly in older people and in fair-skinned, blue-eyed, red- or blonde-haired people who burn easily in the sun. BAD says they are not hereditary, but some risk factors run in families, and people with albinism or xeroderma pigmentosum are at increased risk. People on immunosuppressive drugs, for example organ transplant patients, are at higher risk.

The NHS says there is a small chance the patches could become skin cancer. BAD says that if left untreated for many years there is a very small risk that an actinic keratosis can progress into a form of skin cancer called squamous cell carcinoma, and that people with many actinic keratoses are also at a higher risk of developing other types of skin cancer than someone of the same age who has none.

BAD says to seek medical advice if an actinic keratosis develops into a lump or horn, grows very quickly, becomes tender, forms an ulcer or starts to bleed, because these changes could indicate the early onset of skin cancer.

BAD says the appearance of an actinic keratosis is usually enough for a doctor who manages skin problems, for example a GP or dermatologist, to make the diagnosis. In cases of uncertainty, a sample (biopsy) or the whole affected area may be removed surgically under local anaesthetic and examined under a microscope in the laboratory.

BAD says actinic keratoses can be treated but tend to recur over time. Their presence indicates sun damage to the skin, so while an individual patch can be cured, the person is at risk of developing more in the future.

Regular skin checks are therefore part of the plan. The NHS suggests checking your skin regularly for any changes.

The NHS says there are things you can do to stop actinic keratoses getting worse and lower your chances of developing skin cancer: check your skin regularly, use sunscreen with a sun protection factor (SPF) of at least 30 before going out in the sun and reapply regularly, and wear a hat and clothing that fully covers your arms and legs.

It also says not to sunbathe, not to use sunlamps or sunbeds, and not to go into the sun between 11am and 3pm when it is at its strongest. BAD adds that even a tan is a sign of skin damage, and that sunscreen should be applied generously 15 to 30 minutes before going outdoors and reapplied after swimming or towel drying. The NHS says to consider taking 10 micrograms of vitamin D a day if you always cover up outdoors.

See a GP if you notice new patches on your skin, or if patches begin to bleed, get bigger, change colour, feel tender or develop into a lump, or if a patch appears on your lips. The NHS says it is important to get these skin changes checked in case they are being caused by something more serious, such as skin cancer.

On the NHS, a GP can assess patches and may treat them or refer you to a dermatologist. BAD says that if your GP is concerned about your skin, you should be referred to see a consultant dermatologist or a member of their team.

Some people choose a private dermatologist for assessment or treatment such as cryotherapy or photodynamic therapy. BAD notes that photodynamic therapy and laser are only available in certain clinics, so ask where treatment is delivered and what follow-up is arranged.