Actinic Keratosis
In Brief
Actinic keratoses are rough or scaly patches that develop on skin exposed to the sun over many years. They are considered a precursor stage: most do not become cancerous, but some can progress to squamous cell carcinoma. Treatment options range from creams suitable for larger areas to focused treatments with cryotherapy or laser. The choice depends on the number of lesions, their location, and the overall condition of the skin.
Actinic keratoses are rough, scaly patches on the skin caused by years of sun exposure. They are considered precancerous because a small percentage can develop into squamous cell carcinoma. Given Israel's high UV exposure, actinic keratoses are extremely common and should be monitored and treated.
Symptoms
- Rough, dry, or scaly patch of skin, usually less than 2.5 cm
- Flat to slightly raised patch on sun-exposed areas
- Hard, wart-like surface on the skin
- Color ranging from pink to red to brown
- Itching, burning, or tenderness in the affected area
Treatment Options
- Cryotherapy (liquid nitrogen freezing)
- Topical medications (5-fluorouracil, imiquimod, diclofenac)
- Photodynamic therapy (PDT)
- Curettage for thicker lesions
- Laser treatment for widespread areas
Why Mohs Surgery?
While Mohs surgery is not typically the first-line treatment for actinic keratosis, it may be recommended when there is concern about progression to invasive SCC, or when the lesion is in a cosmetically sensitive area.
Learn about Mohs SurgeryTreatment Comparison
| Method | Description | Best For |
|---|---|---|
| Cryotherapy | Freezing with liquid nitrogen. Quick office procedure, heals in 1-2 weeks. | Individual or few lesions |
| 5-Fluorouracil (Efudex) | Topical cream applied daily for 2-4 weeks. Causes redness and crusting during treatment. | Multiple lesions over a wide area |
| Imiquimod (Aldara) | Immune-stimulating cream applied 2-3 times weekly for several weeks. | Multiple lesions, especially on the face |
| Photodynamic therapy (PDT) | Light-activated treatment after applying a photosensitizing agent. | Large areas with many lesions |
| Curettage | Scraping the lesion under local anesthesia. | Thick or hypertrophic lesions |
| Surgical excision | Complete removal with pathological examination of margins. | Suspected progression to SCC |
Frequently Asked Questions
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Read more →This medical content was reviewed and verified by Dr. Yehonatan Kaplan on April 8, 2026