Could that flaky spot be a precancer?

You notice a scaly, dry patch on your upper lip that’s not going away. Or a rough spot on the back of your hand that’s been there for a while. What’s going on?

You could have actinic keratosis (AK), a common skin precancer. That may sound scary. But these skin lesions are highly treatable if you catch them early. That’s why you should have a dermatologist check them out. Here’s how to identify, treat and prevent AKs.

What is actinic keratosis?

AK shows up as rough, scaly patches on the skin that develop from years of sun exposure, according to the Mayo Clinic. They commonly appear on your:

• Face
• Lips
• Ears
• Scalp
• Neck
• Forearms
• Backs of hands

These lesions are precancers. This means they’re damaged cells that can develop into skin cancer over time.

About 10% of AKs will turn into squamous cell skin cancer, says Angela Casey, MD. She’s a micrographic dermatologic surgeon based in Westerville, Ohio.

How to spot a precancer on your skin

Actinic keratoses don’t always look the same. You could notice an area of skin that is:

• Rough or scaly. “They often have a gritty or sandpaper-like feel when you lightly run your finger over them,” says Dr. Casey.
• Flat (patch) or slightly raised (bump)
• Sensitive, itchy or tender to the touch
• Flaky
• Pink, red, brown or colorless

An AK may also disappear and reappear.

How do actinic keratoses start?

AKs don’t necessarily result from a single sunburn, says Dr. Casey. They develop over time from many years of exposure to ultraviolet (UV) rays. “I most commonly see actinic keratoses in patients who have spent a good amount of time outdoors,” she says. “Some examples are farmers, golfers, tennis players, walkers, construction workers and sailors.”

Are you at risk for actinic keratosis?

You are more likely to get AKs if you:

• Have fair skin
• Burn easily and rarely tan
• Are over age 40 (because AKs result from exposure over time)
• Have a weakened immune system
• Live closer to the equator (where the sun is strongest)
• Have had a lot of exposure to UV rays (from time in the sun or tanning beds)

People with darker skin are less likely to develop AKs, says Britta Reierson, MD. She’s the medical director of Optum Everycare. This is because the increased melanin in darker skin helps protect against UV damage. But you should still limit sun exposure and use broad-spectrum sunscreen.

The Optum Store carries a variety of sunscreens to fit your needs. We have you covered.

How to treat actinic keratosis

If you suspect you have an AK, see a dermatologist to get it treated. Your doctor will examine the area and look for signs of skin cancer, according to the American Academy of Dermatology (AAD).

Your doctor will likely remove the AK just to be safe. This can be done by:

• Freezing it with liquid nitrogen, which destroys the cells
   
• Scraping the cells off with a tool called a curet. Sometimes a doctor will follow this procedure with electrotherapy, in which an electric current “burns” off the AK. (Your doctor will numb the area first so that you don’t feel any pain.)
   
• Using a laser to remove the top layer of skin
   
• Treating it with photodynamic therapy (PDT). In this procedure, the doctor applies a chemical solution to your skin, then activates it with a special light. The solution destroys the precancerous cells.

If you have a lot of AKs, your doctor might also prescribe a cream that you can use at home. Most commonly this will be fluorouracil, which goes by the brand names Carac®, Efudex® and Fluoroplex®. You apply the cream daily for 2 to 3 weeks.

The advantage of using medication is that it can get rid of AKs that you can’t even see yet, says the AAD. These treatments can cause redness, tenderness and sometimes even blistering. This happens as the damaged skin peels off and is replaced by new skin.

How to avoid developing AKs

Dr. Casey has 3 words when it comes to AKs: “Prevention, prevention, prevention.” That means protecting your skin from harmful UV rays. The best ways to do that:

• Use broad-spectrum sunscreen every day. (Learn more about choosing and using sunscreen.)
   
• Wear a broad-brimmed hat to protect your face and neck.
   
• Wear long sleeves to protect your arms.
   
• Stay out of the sun during the hottest part of the day.

Sunscreens come in chemical and mineral forms. Both protect you from the sun but in different ways. Chemical sunscreens work by absorbing UV rays. Mineral sunscreens sit on the surface of the skin and deflect UV rays. Tinted versions of mineral sunscreens can also protect you from visible light. This light penetrates skin more deeply than UV rays.

While not all AKs turn into cancerous lesions, doctors agree they should all be treated early. They’re an early distress call from your skin.

“One thing I tell a lot of my patients: This is a warning that your skin has had some damage. This spot is telling us we need to treat it,” says Dr Reierson.

So pay attention to signs of AKs — and see your doctor. Taking care of them now will keep your skin healthy for the long run.

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Additional sources
AK definition: Mayo Clinic (n.d.). “Actinic keratosis”
AK treatment: American Academy of Dermatology (2022). “Actinic Keratosis: Diagnosis and Treatment”