Actinic Keratosis

Actinic Keratoses (AKs) are precancerous growths caused by exessive sun exposure. They are often rough, scaly patches on sun exposed areas of the skin. Squamous Cell Carcinoma, the second most common cause of skin cancer, often starts as an AK and without performing a skin biopsy, it can be almost impossible for a doctor to distinguish an AK from a squamous cell carcinoma. The American Cancer Society, the Skin Cancer Foundation, and the American Academy of Dermatology all recommend that people with AKs seek treatment for them.

Years of sun exposure cause AKs to develop. All AKs, including actinic cheilitis, develop in the skin cells called the “keratinocytes,” which are the tough-walled cells that make up 90% of the epidermis, the outermost layer of skin, and give the skin its texture. Years of sun exposure cause these cells to change in size, shape, and the way they are organized. Cellular damage can even extend to the dermis, the layer of skin beneath the epidermis.

Individuals with fair skin, a history of cumulative sun exposure, or a weak immune system are at greatest risk for developing AKs. These lesions develop on areas of the body that have received years of sun exposure, such as the face, ears, lip, scalp, neck, forearms, and back of the hands. AKs usually appear after age 40 because they take years to develop. However, even teens can have AKs when they live in areas that receive high-intensity sunlight year round, such as Southern California. Research shows that p53, a mutant protein found in sun-damaged cells in the body, is present in more than 90% of people who have AKs and squamous cell carcinomas.

To prevent AKs and skin cancer, the American Academy of Dermatology recommends adopting a comprehensive sun protection program that includes:

  • Avoid tanning. Ultraviolet light from the sun and tanning beds causes skin cancer and wrinkling. If you want to look like you’ve been in the sun, consider using a sunless self-tanning product. When using a self-tanning product, you should continue to use sunscreen.
  • Get vitamin D safely through a healthy diet that includes vitamin supplements. 15 minutes of sun exposure daily is adequate for Vitamin D
  • Generously apply sunscreen to all exposed skin. Before going outdoors, generously apply a sunscreen that has a Sun Protection Factor (SPF) of at least 30 and is broad-spectrum — protects against both ultraviolet (UVA) and ultraviolet B (UVB) rays. While outdoors, re-apply the sunscreen every two hours, even on cloudy days, and after swimming or perspiring.
  • Cover up when you must be in the sun. Wear long sleeves, pants, a wide-brimmed hat, and sunglasses that protect against both UVA and UVB rays.
  • Use extra caution near water, snow, and sand. These reflect the damaging rays of the sun, which can increase your chance of sunburn.
  • When caught in the early stages, AKs and all types of skin cancer are treatable and in most cases, curable. The key to early detection is frequent skin examinations. Performing regular self-examinations and being screened by a dermatologist as needed can help detect AKs and skin cancer in the earliest and most treatable stages. If you find a suspicious skin lesion, be sure to see a dermatologist for diagnosis — even if the lesion seems to appear and then disappear for weeks or months and reappear. Dermatologists receive extensive medical training in skin conditions and have the experience necessary to diagnose various skin lesions. An accurate diagnosis is the first step to successful treatment.

There are several treatment options for AKs, including cryosurgery (freezing), surgical excision, curettage (scraping) with or without electrosurgery (heat generated by an electric current) and topical (applied to the skin) medications. Lasers, chemical peels, dermabrasion, and photodynamic therapy may also be used. Patients who have multiple AKs may not have all lesions treated at the same time, and in some cases, the dermatologist or dermatologic surgeon will use more than one treatment option. If you notice any redness, increased swelling, bleeding, or other concerning signs, see your doctor. If a bacterial infection is also occurring, an antibiotic may be necessary.

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