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Consultant dermatology · London

Actinic keratosis treatment - London.

Private dermatology assessment and treatment of actinic keratosis (AK): cryotherapy, curettage, 5-FU, imiquimod, tirbanibulin, and photodynamic therapy. Field-first thinking to prevent progression to invasive squamous cell carcinoma.

A stethoscope on a clinical desk

What actinic keratosis is

Rough, scaly patches from years of UV.

A pre-malignant skin lesion caused by chronic ultraviolet exposure. Left alone, a small fraction transform to invasive squamous cell carcinoma. Treated properly, the risk falls.

  • Where it appears

    Face, scalp (bald areas), ears, backs of hands and forearms. Anywhere with a long history of sun exposure. Usually felt as sandpaper texture before it is seen.

  • How dangerous it is

    Individual lesion transformation to invasive squamous cell carcinoma is roughly 0.1 to 2 percent per year. The cumulative field risk across many lesions and many years is meaningful.

  • Why organ transplant recipients are different

    Long-term immunosuppression multiplies non-melanoma skin cancer risk many-fold. Aggressive field treatment, chemoprevention and 6-monthly dermatology surveillance are standard.

    • Indicative pricing

    What private actinic keratosis treatment costs.

    Indicative ranges across London dermatology providers.

    Option Indicative range
    Dermatology consultation £180–£320
    Cryotherapy (liquid nitrogen), per session £45–£150
    Curettage and cautery £220–£450
    5-FU 5% cream (Efudix), 4-week course £15–£35 / tube
    Imiquimod 5% (Aldara) or 3.75% (Zyclara) £55–£120 / box
    Tirbanibulin 1% (Klisyri), 5-day course £45–£95 / tube
    Photodynamic therapy (PDT), per session £850–£1,600
    Daylight PDT, per session £280–£450
    Superficial radiotherapy (extensive field) £2,400–£4,500

    Private dermatology and photodynamic therapy services are available at a number of London hospitals and clinics.

    Who it suits

    When AK treatment is the right choice.

    The most common patients, plus the one red flag that means biopsy first, treatment second.

    • Rough, scaly patches on sun-exposed skin

      Typically face, scalp (bald areas), ears, backs of hands and forearms. Often felt before seen: sandpaper texture that will not settle.

    • Long history of sun exposure

      Fair skin, outdoor work, sunbed use, or years abroad. AK is a cumulative UV problem, not a one-summer problem.

    • Field cancerisation

      Multiple patches across one area (a bald scalp, both forearms). Individual risk is low but cumulative risk of an invasive SCC is meaningful.

    • Organ transplant recipient

      Long-term immunosuppression multiplies SCC risk many-fold. You need surveillance, aggressive field treatment, and consideration of chemoprevention.

    • Recurrence after previous cryotherapy

      Lesion has come back, thickened, is bleeding or symptomatic. Time for biopsy and a field approach rather than another freeze.

    • Concern about cosmesis

      Face or scalp lesions you want treated with the least mark. PDT and short-course topicals often give better cosmetic outcomes than repeated cryotherapy.

    • History of skin cancer

      Previous BCC, SCC or melanoma raises AK relevance. Every new rough patch deserves a dermatologist, not a wait-and-see.

    • Red flag: thickened, ulcerated or bleeding

      Any AK that is tender, ulcerated, thickened, rapidly growing or unresponsive to treatment needs biopsy to exclude invasive squamous cell carcinoma.

    Options

    Lesion-directed, field, or a combination.

    What each treatment involves, and where it sits: cryotherapy for a few discrete lesions, creams or PDT for whole-field disease, biopsy or excision when SCC needs excluding.

    • Cryotherapy (liquid nitrogen)

      Cheapest, quickest, best for a few discrete thin lesions. May leave a small hypopigmented mark. Repeat freezes for stubborn lesions carry a higher risk of pigment change.

    • Curettage and cautery

      Scrape and cauterise. Useful for thicker, hyperkeratotic lesions and gives tissue for histology where diagnosis is uncertain.

    • 5-fluorouracil (Efudix, Actikerall)

      4-week self-applied cream that treats the whole field. Expect a brisk inflammatory reaction. Actikerall (5-FU plus salicylic acid) is used for hyperkeratotic AK.

    • Imiquimod (Aldara, Zyclara)

      Immune-modulator cream. Aldara: 4-week course. Zyclara 3.75%: two 2-week cycles with a rest week. Inflammation and crusting are expected.

    • Tirbanibulin (Klisyri)

      Licensed in 2022 for face and scalp AK. Once-daily for 5 days only, with a shorter and milder inflammatory phase than 5-FU or imiquimod.

    • Photodynamic therapy (PDT)

      Photosensitising cream (5-ALA or methyl-ALA / Metvix) activated by red, blue or natural daylight. Excellent cosmesis, better tolerated than long topical courses, more expensive.

    • Excision or superficial radiotherapy

      Excision if diagnostic uncertainty or SCC suspected. Superficial radiotherapy for extensive fields where topicals and PDT have failed or are impractical.

    • Not on the menu

      Ingenol mebutate (Picato) was withdrawn across the UK and EU in 2020 after signals of increased skin tumour risk. Any clinic still using it is out of date.

    Safety and prevention

    Long-term sun protection is the treatment.

    What to expect during and after treatment, and how high-risk patients (organ transplant recipients, previous skin cancer) are managed differently.

    • The reason AK is treated is SCC prevention

      Individual lesion transformation risk is small (roughly 0.1–2% per lesion per year), but across a field of dozens of lesions over years, the cumulative risk of an invasive squamous cell carcinoma is meaningful.

    • When to biopsy

      Thickened, ulcerated, bleeding, painful, rapidly changing or treatment-resistant lesions need a punch or shave biopsy to exclude invasive SCC before another round of topical treatment.

    • What topical treatments feel like

      Expect real redness, crusting, weeping and discomfort during 5-FU and imiquimod courses. This is the drug working. Tirbanibulin and PDT are usually shorter and milder.

    • Pigment and scarring

      Repeated cryotherapy can leave permanent hypopigmented spots, particularly on darker skin. PDT and topicals generally give better cosmesis on the face and scalp.

    • Sun protection is the treatment

      Broad-spectrum SPF 50+ (mineral where possible) daily to the affected area, wide-brim hat, UV-protective clothing, and avoidance of midday sun. This alone reduces new AK development.

    • High-risk patients need more

      Organ transplant recipients: consider oral acitretin 10–25 mg daily for chemoprevention and 6-monthly dermatology review. Oral nicotinamide 500 mg twice daily reduces new AK and non-melanoma skin cancer in high-risk patients.

    • Self-surveillance

      Photograph your scalp and forearms every few months. Any new, changing, bleeding or ulcerated spot is a same-week phone call, not a wait-and-see.

    • Red flags

      Tender lump, ulcer that will not heal, rapidly growing nodule, bleeding lesion, or a patch unresponsive to a full topical course: back to the dermatologist for biopsy.

    Recognised by major UK insurers

    BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

    Most UK insurers cover dermatology assessment, biopsy and treatment where AK is symptomatic or high-risk. Cosmetic-only concerns are typically self-pay.

    Frequently asked

    Common questions about actinic keratosis.

    • Is actinic keratosis skin cancer?

      No, but it is pre-malignant. Each individual lesion has a low chance of transforming to invasive squamous cell carcinoma (roughly 0.1 to 2 percent per lesion per year), but across a field of many lesions over many years the cumulative risk is meaningful. That is why it is treated.

    • Does treatment hurt?

      Cryotherapy stings briefly and can blister. 5-FU and imiquimod cause weeks of redness, crusting and discomfort in the treated field. Tirbanibulin and PDT are usually shorter and better tolerated. A good dermatologist tells you exactly what to expect before you start.

    • Will private medical insurance pay?

      Most UK insurers cover consultant assessment and biopsy where clinically indicated. Some cover treatment where AK is symptomatic or high-risk. Cosmetic-only concerns are typically self-pay. Check with your insurer which route to try before you book.

    • Will my actinic keratosis come back after treatment?

      Often, yes. AK is a sign of a sun-damaged field, and new lesions can appear in the same area. Field treatments (5-FU, imiquimod, PDT) reduce recurrence more than lesion-directed cryotherapy alone, but long-term sun protection and surveillance are essential.

    • How do I stop new lesions developing?

      Daily broad-spectrum SPF 50+ (mineral is well tolerated), a wide-brim hat, UV-protective clothing, avoidance of midday sun and no sunbeds. High-risk patients (organ transplant, multiple prior skin cancers) benefit from oral nicotinamide 500 mg twice daily and, where appropriate, acitretin.

    • Do I need a patch test?

      Not for cryotherapy or curettage. For photodynamic therapy no patch test is needed, but photosensitivity for 48 hours after treatment is expected. For 5-FU and imiquimod, allergy is rare, and a dermatologist will confirm suitability during assessment.

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