Actinic Keratosis - Dr Colin Hong

Actinic keratosis, also known as solar keratosis, is a common condition characterized by scaly or crusty patches on the skin that develop due to prolonged sun exposure. These patches are typically found on areas of the skin that are frequently exposed to the sun, such as the face, ears, scalp, hands, and arms.

Actinic keratosis is considered a precancerous condition, as it can progress to a type of skin cancer called squamous cell carcinoma if left untreated. In this blog post, we will discuss the causes, symptoms, treatment options for actinic keratosis, and tips for preventing the condition.

History and Definition

Actinic keratosis, also known as solar keratosis or senile keratosis, is a common skin condition caused by prolonged sun exposure. The condition was first described by Dubreuilh in 1826 and later renamed by Pinkus as actinic keratosis in 1958.

Despite being traditionally classified as precancerous lesions, recent research suggests that actinic keratoses may be considered in situ neoplasms, as they arise from clonal DNA modifications in keratinocytes and display characteristics of malignancy such as loss of polarity, nuclear pleomorphism, and increased number of mitoses.

Additionally, actinic keratoses have the potential to progress into non-melanoma skin cancer, specifically squamous cell carcinoma. They occur most commonly in sun-exposed areas of the skin such as the face, ears, scalp, hands, and arms.


Actinic keratoses can present in various ways, and symptoms may vary depending on the individual case. Common symptoms include:

  • Rough, scaly or dry patches of skin, typically measuring less than 1 inch in diameter

  • Patches or bumps on the top layer of skin that may be flat or slightly raised

  • Hard, wart-like surfaces in some cases

  • Color variations including pink, red or brown

  • Itching, burning, bleeding or crusting

  • New patches or bumps appear on sun-exposed areas such as the head, neck, hands, and forearms.

  • It’s important to note that not everyone with actinic keratoses will have symptoms and they may be asymptomatic, but they still have the potential to develop into skin cancer.


Actinic keratoses are caused by prolonged or intense exposure to ultraviolet (UV) rays from the sun or tanning beds. UV rays damage the DNA in skin cells, causing mutations that can lead to the development of actinic keratoses.

People with fair skin, light-colored eyes, and hair are at a higher risk for developing actinic keratoses, as are people who spend a lot of time outdoors or have a history of sunburns. Additionally, people who use tanning beds are at an increased risk for developing actinic keratoses and other types of skin cancer.


Actinic keratosis can be diagnosed by a primary healthcare provider by visual examination of the affected area. If the provider is uncertain, they may perform a skin biopsy to confirm the diagnosis. During a skin biopsy, a small sample of skin is removed and analyzed under a microscope. The biopsy procedure can usually be done in the clinic with a numbing injection to minimize discomfort.

It’s important to note that even after treatment for actinic keratosis, it’s recommended to undergo regular skin checkups with a healthcare provider at least once a year to monitor for any signs of skin cancer. This is because actinic keratoses have the potential to progress into squamous cell carcinoma, a type of non-melanoma skin cancer.


Actinic keratoses can sometimes disappear on their own, but they may reoccur with further sun exposure. Since it is difficult to determine which actinic keratoses will develop into skin cancer, they are typically removed as a precautionary measure.

Treatment options for actinic keratoses include:


Medicated creams or gels such as fluorouracil (Carac, Efudex, others), imiquimod (Aldara, Zyclara), or diclofenac. These medications may cause inflammation, scaling, or a burning sensation for a few weeks.


Surgical and other procedures such as freezing (cryotherapy), scraping (curettage), laser therapy, and photodynamic therapy. These methods can be done in a healthcare provider’s office and have various side effects such as blisters, scarring, changes to skin texture, infection and changes in the skin color of the affected area. Cryotherapy is the most common treatment.

After the surgery, the affected area may be sore, swollen, and red. Wounds should be kept clean and dry. The skin may take several weeks to heal, and there may be some scarring. The treated area should be protected from the sun to prevent further AKs from developing.

It’s important to note that after treatment, the skin should be protected from further sun exposure, as actinic keratoses can reoccur with sun exposure. Your healthcare provider might also recommend regular skin checkups to monitor for any signs of skin cancer.

Risk Factors

Risk factors for developing actinic keratoses include:

  • Having fair skin, red or blond hair, and blue or light-colored eyes


  • A history of excessive sun exposure or sunburn, especially during childhood


  • Tending to freckle or burn easily when exposed to sunlight


  • Being over the age of 40


  • Living in a sunny climate or working outdoors


  • Having a weakened immune system due to a medical condition or treatment

It is important to note that actinic keratoses have the potential to progress into skin cancer if left untreated. Therefore, it is crucial to protect your skin from the sun and have any suspicious growths checked by a healthcare professional.


Actinic keratoses are considered pre-cancerous growths that can develop into squamous cell carcinoma if left untreated. This type of skin cancer is usually not life-threatening if caught early and treated properly. However, if the condition is not diagnosed or treated on time, it can progress and potentially spread to other parts of the body, becoming more difficult to treat.

Additionally, actinic keratoses can also be a sign of a more serious underlying condition, such as an immune disorder or chronic sun damage. It is important to have any suspicious growths checked by a healthcare professional to determine the best course of treatment.

When to See a Doctor

It is important to see a healthcare professional if you notice any new or changing growths on your skin that resemble actinic keratoses. These spots are usually rough, and scaly, and may be red, pink, or flesh-colored. They can appear on any sun-exposed area of the body but are most commonly found on the face, ears, scalp, neck, forearms, and back of the hands.

Some other signs that may indicate a need to see a doctor include:

  • A spot that bleeds or becomes crusty
  • A spot that is larger than a pencil eraser
  • A spot that is painful or itchy
  • A spot that has an irregular border or multiple colors
  • A spot that continues to grow or change in appearance

Step-by-Step Guide to Actinic Keratosis Treatment

AKs are treatable, and early treatment is important to prevent the development of squamous cell carcinoma, a type of skin cancer. Here is a step-by-step guide to treating actinic keratosis:


The first step in treating AK is to consult a dermatologist or a plastic surgeon. They will conduct a thorough examination of the skin and confirm the diagnosis of AK.

Choosing the Right Treatment

The doctor will recommend the most appropriate treatment option based on the number, size, and location of the AKs, as well as the patient’s age, overall health, and personal preferences. Treatment options include:

  • Topical creams and gels: These are applied to the skin and work by destroying the abnormal cells in the AK. Examples include imiquimod (Aldara), 5-fluorouracil (Efudex), and ingenol mebutate (Picato).


  • Cryotherapy: This involves freezing the AKs using liquid nitrogen.


  • Photodynamic therapy: This involves applying a light-sensitizing medication to the skin and then exposing it to a special type of light.


  • Surgical excision: This involves cutting out the AKs and stitching the area closed. This is typically done if the AKs are large or in areas where scarring is acceptable.

Post Instructions

After treatment, the doctor will provide instructions on how to care for the treated area and monitor for any changes. Follow-up appointments will be scheduled to monitor the progress of the treatment and to check for any new AKs.


Actinic keratosis (AK) is a skin condition that develops from prolonged sun exposure and is characterized by rough, scaly patches on the skin, commonly found on sun-exposed areas such as the face, ears, scalp, neck, forearms and back of the hands. It is considered pre-cancerous and if left untreated, it may progress to a type of skin cancer called squamous cell carcinoma.

Individuals with fair skin, red or blond hair, blue or light-colored eyes, a history of sunburn, age over 40, living in a sunny area, working outdoors and having a weakened immune system are at higher risk of developing AK. Regular skin check-ups and protecting the skin from sun exposure can help prevent and treat AK.


If you are looking for a reliable and experienced plastic surgeon in Toronto who specializes in actinic keratosis treatment, Dr. Colin Hong is one of the best options available. He has over 35 years of experience in Cosmetic, Plastic, and Reconstructive surgeries in Toronto, North York, and Markham with some of the most competitive prices available. 

Dr. Colin Hong offers a comprehensive approach to treating actinic keratosis. Depending on the severity of your condition, his treatments may include topical medications such as creams or lotions, cryotherapy (freezing), photodynamic therapy (PDT), and laser surgery. He will use the latest technology and techniques available to ensure that you get the best results from your treatment. 

To request a consultation with Dr. Colin Hong today, please contact us at (416) 222-6986 or email us at Make sure you leave your full name, email, and phone number so we can reach you on time. Please also obtain a referral from your family doctor to set up an appointment for AK treatment with Dr. Hong.

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