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.
Why patients choose us
- 01
A consultant dermatologist, treating
A named GMC-registered dermatologist assesses and treats you, biopsies where suspicious, and plans field versus lesion-directed care.
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Field-first thinking, not lesion-by-lesion
Chronic UV damage is a field problem. We route to clinicians who treat the whole affected area, not just the bumps you can feel.
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Independent, and free
We are paid by no clinic. The recommendation, and whether you need biopsy first, is impartial and costs you nothing.
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 our vetted London dermatology network. Send photos and we quote firm figures within one working day.
| Option | Indicative range | Time | Turnaround |
|---|---|---|---|
| Dermatology consultation | £180–£320 | 30–45 min | Same visit |
| Cryotherapy (liquid nitrogen), per session | £45–£150 | 10–15 min | Same visit |
| Curettage and cautery | £220–£450 | 20–30 min | Same visit |
| 5-FU 5% cream (Efudix), 4-week course | £15–£35 / tube | Home | 4 weeks |
| Imiquimod 5% (Aldara) or 3.75% (Zyclara) | £55–£120 / box | Home | 2–4 weeks |
| Tirbanibulin 1% (Klisyri), 5-day course | £45–£95 / tube | Home | 5 days |
| Photodynamic therapy (PDT), per session | £850–£1,600 | 2–3 hours | Same visit |
| Daylight PDT, per session | £280–£450 | 2 hours | Same visit |
| Superficial radiotherapy (extensive field) | £2,400–£4,500 | Course | Weeks |
Where we work: Cadogan Clinic Skin Cancer Unit, Cranley Clinic Photodynamic Therapy, London Dermatology Centre, HCA Wellington Dermatology, Chelsea and Westminster Private, Skin Care Clinic, and King's Private Dermatology.
The journey
From enquiry to review.
One team from first message through consultation, biopsy where needed, treatment and follow-up.
- 01
Before
You send photos and a short history
Where the lesions are, how long you have had them, any prior skin cancers, medications, and immunosuppression status.
- 02
Before
We come back with a matched dermatologist
Within one working day: a consultant option, an indicative price, and whether biopsy is likely to be needed first.
- 03
Before
Consultant assessment
Full skin examination with dermatoscopy. Biopsy of any hyperkeratotic, thickened, ulcerated or symptomatic lesion to exclude invasive SCC.
- 04
On the day
Treatment
Cryotherapy or curettage on the day for discrete lesions. Field treatments (5-FU, imiquimod, tirbanibulin, PDT) planned and started with written instructions.
- 05
After
Review
Follow-up at 4 to 12 weeks depending on treatment. Anything unresponsive or suspicious is biopsied. Long-term surveillance plan agreed.
Who it suits
When AK treatment is the right choice.
The patients we see most, plus the one red flag that means biopsy first, treatment second.
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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.
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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.
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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.
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Organ transplant recipient
Long-term immunosuppression multiplies SCC risk many-fold. You need surveillance, aggressive field treatment, and consideration of chemoprevention.
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Recurrence after previous cryotherapy
Lesion has come back, thickened, is bleeding or symptomatic. Time for biopsy and a field approach rather than another freeze.
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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.
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History of skin cancer
Previous BCC, SCC or melanoma raises AK relevance. Every new rough patch deserves a dermatologist, not a wait-and-see.
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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.
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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.
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Curettage and cautery
Scrape and cauterise. Useful for thicker, hyperkeratotic lesions and gives tissue for histology where diagnosis is uncertain.
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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.
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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.
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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.
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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.
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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.
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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.
Our vetted London network
Consultant dermatologists, we picked them.
Skin-cancer-experienced dermatologists across London and the major UK cities. Introductions made privately, once we understand your history.
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Consultant dermatologists with a named GMC number and specialist skin-cancer experience
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Clinics with in-house dermatoscopy, biopsy, curettage, cryotherapy and PDT under one roof
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CQC-registered settings with a written pathway to Mohs, plastics and oncology if invasive SCC is found
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Willingness to biopsy first when in doubt, and to say when no active treatment is the right answer
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.
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The reason we treat AK 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.
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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.
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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.
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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.
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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.
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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.
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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.
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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
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
Everything we get asked about actinic keratosis.
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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 we treat.
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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.
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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. We tell you which route to try before you book.
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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.
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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.
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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.
Related treatments
Looking for something else?
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Mohs micrographic surgery
Tissue-sparing removal for skin cancer.
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PDT for AK and BCC
Photodynamic therapy for field disease.
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Superficial radiotherapy
Non-surgical option for skin cancer and extensive AK.
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Sentinel node biopsy (melanoma)
Staging for high-risk melanoma.
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Mole mapping
Total-body photography and surveillance.
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Melasma treatment
Pigment disorder management.
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