Precancerous conditions of the skin

Actinic keratosis is a precancerous condition of the skin. Precancerous conditions of the skin are changes to the skin cells that make them more likely to develop into cancer. Actinic keratosis is not yet cancer. But if it isn’t treated, it may develop into a type of non-melanoma skin cancer called squamous cell carcinoma. Actinic keratosis is also called solar keratosis.

Actinic keratosis most often develops on areas exposed to the sun, such as the face, ears, neck, bald scalp, arms and backs of hands.

Long-term unprotected exposure to the sun is the main risk factor for actinic keratosis. Other risk factors that increase your chance of developing actinic keratosis are:

• fair skin
• light-coloured hair, especially blond or red
• older age
• weakened immune system

Actinic keratosis often appears as small, rough patches on the skin that feel like sandpaper. These patches can get bigger and turn red or brown. They may be itchy or burn. There may be many patches close together in one area. There is usually more than one area of actinic keratosis.

Your doctor will do a physical exam of the skin to diagnose actinic keratosis. A punch biopsy or shave biopsy may be done if the doctor can’t tell if it is actinic keratosis or skin cancer. Find out more about punch biopsy and shave biopsy.

Treatment options for actinic keratosis usually depend on the number of abnormal areas and where they are. Treatments include:

• active surveillance (also called watchful waiting)
• medicines put directly on the skin as a cream or gel (called topical), such as 5-fluorouracil (5-FU, Efudex, Actikerall), ingenol mebutate (Picato) and imiquimod (Aldara, Zyclara)
• cryosurgery
• curettage and electrodesiccation (scraping with a sharp tool to remove an abnormal area, followed by applying an electrical current to stop bleeding and destroy any remaining abnormal tissue)
• surgical excision with a shave biopsy (also called shave excision)
• photodynamic therapy (PDT)