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Actinic keratosis

See also in: External and Internal Eye,Hair and Scalp
Contributors: Rajini Murthy MD, Vivian Wong MD, PhD, Elyse M. Love MD, Sarah Hocker DO, Susan Burgin MD
Other Resources UpToDate PubMed


Actinic keratoses (AKs) are considered precancerous lesions and present as rough, scaly macules or patches arising on chronically sun-exposed skin. This is a very common condition in individuals with lighter skin colors and is virtually unseen in people with darker skin colors. AKs are commonly seen on sun-exposed skin of the face, ears, scalp (areas of hair loss), neck, upper chest, forearms, dorsal hands, shins, and, less commonly, the eyelids and periocular region. These flat, scaly papules are of varying sizes and usually begin as "rough" localized skin lesions that the patient feels but are difficult to see. They are usually asymptomatic but may be tender.

The frequency of AKs increases with age and cumulative lifetime sun exposure. They are also more common in individuals who are immunosuppressed (especially after solid organ transplantation) and in males. They may resolve with protection from ultraviolet (UV) light. Some medications (ie, capecitabine, sorafenib) may induce inflammation of existing AKs.

Patients with AKs are at higher risk for developing nonmelanoma skin cancer. AKs have the potential to evolve into squamous cell carcinoma (SCC). It is estimated that the likelihood that a given AK will evolve into an invasive SCC is approximately 0.075%-0.096% per lesion.

The term "field cancerization" is used to describe areas of skin at risk for both AK and SCC. Clinically, this manifests as numerous AKs and squamous cell carcinoma in situ (SCCis) with or without invasive SCCs in a field of chronically sun-damaged skin. Risk factors include male sex, lighter skin color, older age, underlying immunosuppression, and the degree of prior exposure to UV light.

Related topic: actinic cheilitis


L57.0 – Actinic keratosis

201101007 – Actinic keratosis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Superficial basal cell carcinoma
  • Squamous cell carcinoma in situ (Bowen disease)
  • Psoriasis
  • Flat wart
  • Common wart
  • Seborrheic dermatitis – Patients with significant seborrheic dermatitis will benefit from initial treatment of dermatitis before beginning treatment for AK.
  • Cutaneous squamous cell carcinoma
  • Seborrheic keratosis
  • Discoid lupus erythematosus
  • Disseminated superficial actinic porokeratosis
  • Severe Xerosis – Wiping the skin with water or an alcohol pad will minimize background xerosis. In addition, xerosis lacks the classic gritty sensation on light palpation.
  • Solar lentigo (pigmented variant)
  • Lentigo maligna (pigmented variant)

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:12/18/2021
Last Updated:02/10/2022
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Patient Information for Actinic keratosis
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Actinic keratosis
See also in: External and Internal Eye,Hair and Scalp
A medical illustration showing key findings of Actinic keratosis : Sun-exposed distribution
Clinical image of Actinic keratosis - imageId=82332. Click to open in gallery.  caption: 'An adherent mound of scale atop a thin pink plaque.'
An adherent mound of scale atop a thin pink plaque.
Copyright © 2024 VisualDx®. All rights reserved.