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Actinic Keratosis

Actinic keratosis is a precancer, or a skin abnormality that could lead to cancer. Actinic keratoses form when cells in the top layer of skin begin to grow abnormally. The most likely location for an actinic keratosis is sun-exposed skin. If you notice one actinic keratosis, it is likely that you have others.1,2

Many actinic keratoses never progress. About one-quarter go away on their own.3 However, up to 10% of actinic keratoses progress to squamous cell carcinoma.4 For this reason, your doctor might suggest treating these lesions.

Actinic keratoses have many different appearances. Common presentations are described below. However, it can be hard to identify what kind of lesion you are seeing. If you notice changes in your skin, discuss them with your primary care provider or dermatologist.

Where does actinic keratosis develop?

More than 80% of actinic keratoses develop on skin that gets frequent sun exposure.3 The nose, cheeks, and lips are common locations. Actinic keratoses also develop on the ears, temple, forehead, scalp, shoulders, and neck. They may be found on the back of the hands and forearms.3,5

What does actinic keratosis look like?

Actinic keratoses range in size from a tiny spot to 1 inch in diameter.5

These lesions appear in many different ways.1,2,5 They are often described as crusty, scaly, or rough. Some people describe the affected area as “feeling like sandpaper.” Actinic keratosis may look like a bump, patch, plaque, or horn. The color ranges widely. Normal skin color, red, or pink are common. Some actinic keratoses are brown, white, yellow, or silvery.

Actinic cheilitis is a type of actinic keratosis that develops on the lower lip.5,6 Symptoms include chapping and cracking. The lesion may appear white or brown. The lip may feel like sandpaper.

What symptoms of actinic keratosis might I have?

Aside from noticing the lesion, you may not feel any symptoms.3 In some cases, actinic keratoses itch or burn.3 It may be painful to rub the lesion.1

What else could this skin lesion be?

Other conditions that may have a similar appearance as actinic keratosis are:7,8

  • Cutaneous lupus erythematosus
  • Age spots/Liver spots
  • Seborrheic keratoses
  • Bowen disease (also called squamous cell carcinoma in situ)
  • Squamous cell carcinoma
  • Basal cell carcinoma
  • Melanoma
Written by: Sarah O'Brien | Last reviewed: May 2017.
  1. American Academy of Dermatology. Actinic keratosis. Accessed February 27, 2017 at:
  2. DermNet New Zealand. Actinic keratosis. Accessed February 27, 2017 at:
  3. McIntyre WJ, Downs MR, Bedwell SA. Treatment options for actinic keratoses. Am Fam Physician. 2007;76:667-671.
  4. Firnhaber JM. Diagnosis and treatment of basal cell and squamous cell carcinoma. Am Fam Physician. 2012;86:161-168.
  5. Skin Cancer Foundation. Actinic keratosis warning signs and images. Accessed February 27, 2017 at:
  6. Bentley JM, Barankin B, Lauzon GJ. Paying more than lip service to lip lesions. Can Fam Physician. 2003;49:1111-1116.
  7. Morse MJ. Keys to diagnosing and treating actinic keratosis. Podiatry Today. 2014;27. Accessed February 28, 2017 at:
  8. Spencer JM, James WD, Jordan L, et al. Actinic keratosis differential diagnosis. Medscape. Updated April 7, 2016. Accessed February 28, 2017 at: