Actinic Keratosis Clinical Presentation

Updated: Jun 03, 2021
  • Author: James M Spencer, MD; Chief Editor: William D James, MD  more...
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Actinic keratoses are seen almost exclusively in whites, especially those with skin phototypes I and II. [4] The incidence increases with each decade of life, and men have a slightly increased frequency of actinic keratosis. [4, 21] Actinic keratosis is correlated with long-term UV exposure, such as occurs in persons with outdoor occupations. [4]

Patient who are immunosuppressed following organ transplantation are at markedly increased risk of developing actinic keratoses. [29] The lesions still arise in areas of long-term exposure, [6, 27, 38] and they are thought to be actinically induced.


Physical Examination

The typical patient with actinic keratoses is an elderly, fair-skinned, sun-sensitive person. [4] The lesions arise in areas of long-term sun exposure, including the face, ears, bald scalp in men, and the dorsal forearms and hands. [5, 6] Actinic keratoses begin as small rough spots that are easier felt than seen, often described as being similar to rubbing sandpaper. [1] With time, the lesions enlarge, usually becoming red and scaly; most are only 3-10 mm, but they may enlarge to several centimeters. [1, 2, 3] Note the images below.

Actinic keratosis. Courtesy of Hon Pak, MD. Actinic keratosis. Courtesy of Hon Pak, MD.
Erythematous, scaly lesions on the temple area, ty Erythematous, scaly lesions on the temple area, typical of actinic keratosis.

Patients may develop multiple lesions within a single anatomic area, to the extent that the lesions collide and produce confluent actinic keratosis over a relatively large area. Variants may be brown (pigmented actinic keratosis), atrophic, bowenoid, lichen planus–like, or have exaggerated hyperkeratosis, producing a hornlike projection above the skin surface known as a cutaneous horn. [7]



Lesions may progress into invasive squamous cell carcinomas. A biopsy should be performed on nodular, indurated, or unresponsive lesions. [9]