ACTINIC KERATOSES

CLINICAL OVERVIEW & TREATMENT APPROACH

Actinic keratoses (AKs) are precancerous skin lesions caused by cumulative ultraviolet (UV) exposure. They commonly develop on chronically sun-exposed areas such as the face, scalp, ears, neck, forearms, and backs of the hands.

AKs may appear as rough, scaly, crusted, or thickened areas that are sometimes easier to feel than to see. A patient may have a single lesion or numerous lesions within a broader area of sun-damaged skin.

Actinic keratoses represent abnormal changes in sun-damaged skin cells. Although not every AK progresses, some may develop into squamous cell carcinoma (SCC). Evaluation is therefore important not only to identify and treat actinic keratoses, but also to recognize lesions that may already represent a more advanced process.

At International Vein & Skin Institute, actinic keratoses are evaluated and treated by Dr. Jozef Tryzno, MD. Treatment is selected according to the number, thickness, distribution, anatomic location, surrounding sun damage, and clinical characteristics of the lesions.

CLINICAL EVALUATION

Evaluation begins with focused clinical examination and, when appropriate, dermoscopic assessment.

Important findings include:

Rough, scaly, or thickened surface
Persistent or recurrent lesions
Red, pink, tan, or pigmented changes
Tenderness or sensitivity
Crusting or bleeding
Increasing thickness or growth
Extent of surrounding sun damage

Actinic keratoses may occur individually or within areas containing multiple clinically visible and less apparent sun-damaged lesions.

WHEN BIOPSY MAY BE NEEDED

Not every rough or scaly lesion on sun-damaged skin is an actinic keratosis.

A lesion that is thickened, tender, rapidly enlarging, persistently crusted or bleeding, atypical in appearance, or uncertain in diagnosis may require biopsy and histopathologic examination.

Biopsy may help distinguish actinic keratosis from squamous cell carcinoma or another skin lesion and guide appropriate treatment.

For some procedures or insurance plans, histopathologic confirmation may also be required before treatment authorization.

INDIVIDUAL LESIONS VS. FIELD SUN DAMAGE

Treatment planning depends substantially on whether the patient has one or several distinct actinic keratoses or a larger area of chronically sun-damaged skin containing multiple lesions.

Individual lesions can be treated directly. When numerous AKs develop across the face, scalp, or another sun-exposed area, treatment may instead address the broader field of damaged skin rather than treating only the most visible lesions.

This distinction helps determine whether lesion-directed treatment, field-directed treatment, or a combination of approaches is most appropriate.

TREATMENT OPTIONS AT IVSI

Treatment is individualized according to the number and distribution of lesions, lesion thickness, diagnostic certainty, anatomic location, and extent of surrounding sun damage.

CO₂ LASER DESTRUCTION — SELECT LESIONS

Ablative CO₂ laser treatment may be used for selected actinic keratoses requiring precise destructive treatment.

The laser allows controlled removal or evaporation of abnormal tissue with limited procedural bleeding. Treatment depth can be adjusted according to the thickness and location of the lesion.

CO₂ laser treatment may be particularly useful when multiple discrete lesions require treatment within a defined area.

SURGICAL REMOVAL / BIOPSY — SELECT LESIONS

Lesions that are thicker, clinically atypical, or diagnostically uncertain may require removal or biopsy rather than direct destruction.

Preserving tissue allows histopathologic examination to establish the diagnosis and determine whether more advanced treatment is necessary.

TOPICAL FIELD THERAPY

For patients with multiple actinic keratoses or broader areas of sun-damaged skin, prescription topical medications may be used to treat an entire affected field rather than individual visible lesions.

Topical field therapy may be used to:

Treat multiple actinic keratoses within a sun-damaged area
Address visible and less apparent areas of actinic damage
Provide an alternative to procedural field treatment
Complement lesion-directed treatment when thicker or more prominent lesions require separate management

Treatment produces a controlled inflammatory response in abnormal sun-damaged skin. Redness, inflammation, crusting, and healing vary depending on the treatment selected, area being treated, duration of therapy, and extent of underlying sun damage.

Follow-up allows the treatment response and healing to be assessed before additional treatment is considered.

PHOTODYNAMIC THERAPY (PDT)

Photodynamic therapy provides another field-directed approach for patients with multiple actinic keratoses and broader areas of sun-damaged skin.

A photosensitizing medication is applied to the treatment area and allowed an appropriate incubation period. The area is then exposed to a specific light source, activating the medication and producing a controlled reaction within the treated sun-damaged skin.

PDT may be particularly useful for:

Multiple actinic keratoses
Diffuse sun damage involving the face or scalp
Areas containing numerous visible and less apparent lesions
Patients who benefit from treatment of a broader sun-damaged field rather than individual lesions alone

The expected inflammatory response and healing period depend on the treatment area, degree of sun damage, and treatment protocol.

INDIVIDUALIZED & COMBINATION TREATMENT

There is no single treatment approach for every patient with actinic keratoses.

A patient with one suspicious or thickened lesion may require biopsy or surgical treatment, while several discrete AKs may be treated individually. Patients with numerous lesions and extensive surrounding sun damage may benefit from topical field therapy, photodynamic therapy (PDT), or a combination of lesion-directed and field-directed treatment.

In some patients, a thicker or diagnostically uncertain lesion may be treated individually while the surrounding field of actinic damage is treated separately.

Treatment is selected according to the clinical presentation, lesion characteristics, extent of sun damage, treatment area, and expected healing.

SPECIAL ANATOMIC CONSIDERATIONS

Actinic keratoses frequently occur on highly visible or functionally sensitive areas, including the face, ears, scalp, eyelids, and lips.

Treatment planning considers skin thickness, lesion depth, surrounding structures, expected healing, scar risk, and the need for diagnostic tissue.

Careful technique selection is particularly important in these locations because treatment must adequately address abnormal tissue while preserving surrounding healthy skin and function.

YOUR ROLE IN PROPER HEALING

Healing depends on the treatment performed and the extent of the treated area.

After lesion-directed procedures, temporary redness, crusting, tenderness, or superficial wound formation may occur. Field treatment can produce a more widespread inflammatory response across the treated sun-damaged skin.

Following treatment, the skin should be protected according to the specific aftercare instructions provided. Sun protection is particularly important, both during healing and to reduce continued ultraviolet injury.

IMPORTANT PROCEDURAL CONSIDERATIONS

Actinic keratoses develop as a consequence of cumulative ultraviolet damage. Treating existing lesions does not eliminate the underlying sun damage or prevent additional lesions from developing.

New or recurrent lesions may therefore appear over time, and ongoing skin surveillance is important, particularly in patients with extensive actinic damage or a history of skin cancer.

Lesions that persist, enlarge, become increasingly thick or tender, bleed, or change despite treatment require reassessment.

SCHEDULE A SKIN LESION EVALUATION

An evaluation can help distinguish actinic keratoses from other sun-related skin lesions and determine whether biopsy, lesion-directed treatment, field treatment, or another approach is appropriate.

📞 Call (847) 518-9999 to schedule a dermatology or surgical evaluation.

Medical Disclaimer
This information is provided for educational purposes only and does not replace individualized medical evaluation. Treatment recommendations depend on clinical findings, diagnostic requirements, and patient-specific factors. Outcomes may vary, and no specific medical or cosmetic result can be guaranteed.

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