ACTINIC KERATOSES

CLINICAL OVERVIEW & TREATMENT APPROACH

Actinic keratoses (AKs) are premalignant skin lesions that develop as a result of chronic ultraviolet (UV) exposure. They most commonly appear on sun-exposed areas such as the face, scalp, ears, neck, forearms, and dorsal hands.

These lesions represent early abnormal changes in skin cells and may progress over time. While many actinic keratoses remain stable, some may evolve into squamous cell carcinoma, making proper evaluation and management important.

CLINICAL EVALUATION

Evaluation of suspected actinic keratoses typically includes:

• Focused clinical examination
• Dermoscopic assessment, when appropriate
• Review of lesion characteristics, including:
  • Texture (rough, scaly, or thickened)
  • Color changes
  • Persistence or recurrence
  • Symptoms such as tenderness or bleeding

In sun-damaged skin, actinic keratoses may be subtle and difficult to distinguish from other benign or malignant lesions, making medical evaluation essential.

WHEN DIAGNOSTIC CONFIRMATION IS REQUIRED

In certain situations, histopathologic confirmation is required before definitive treatment can proceed.

A biopsy may be necessary when:

• The diagnosis is uncertain based on clinical or dermoscopic evaluation
• Lesion features raise concern for malignancy
• Pathology confirmation is required to establish medical necessity and support insurance authorization for procedural treatment

For some insurance plans, pathology results confirming diagnosis are required prior to authorization of treatments such as:

• Ablative CO₂ laser destruction of multiple lesions, particularly on the face or scalp
• Photodynamic therapy (PDT)
• Surgical excision or other definitive procedures

Biopsy enables accurate diagnosis, guides appropriate treatment selection, and supports compliance with medical and insurance requirements.

TREATMENT OPTIONS

Treatment decisions are individualized and based on:

• Number and distribution of lesions
• Lesion thickness and clinical behavior
• Anatomic location
• Patient history and cumulative sun exposure

Depending on clinical findings, treatment options may include:

• Surgical excision, when indicated
• Photodynamic therapy (PDT) for field-directed treatment
• Other medically appropriate procedural or destructive techniques

The goal of treatment is to remove abnormal cells, reduce the risk of progression, and preserve surrounding healthy tissue.

PHOTODYNAMIC THERAPY (PDT)

Photodynamic therapy may be considered for patients with:

• Multiple actinic keratoses
• Diffuse sun-damaged skin (“field cancerization”)
• Lesions not suited for individual excision

PDT involves application of a photosensitizing agent followed by controlled light activation to selectively target abnormal cells. Treatment planning is individualized based on lesion extent and patient tolerance.

SPECIAL ANATOMIC CONSIDERATIONS

Lesions on cosmetically or functionally sensitive areas—such as the face, ears, eyelids, scalp, and lips—require careful procedural planning.

Treatment selection accounts for:

• Skin thickness and healing characteristics
• Scar risk
• Functional preservation
• Need for precision and controlled tissue removal

POST-TREATMENT CARE & FOLLOW-UP

Post-procedure care depends on the treatment performed and may include:

• Local wound care instructions
• Sun protection recommendations
• Monitoring for recurrence or new lesions

Because actinic keratoses reflect cumulative sun damage, ongoing surveillance may be recommended.

MEDICAL VS. COSMETIC CARE

Treatment of actinic keratoses is performed for medical reasons, including reduction of progression risk and management of sun-induced skin damage.

While treatment may improve skin appearance, cosmetic improvement is not the primary goal.

Learn more about our approach to Skin Surgery & CO₂ Laser Procedures.

SCHEDULE AN EVALUATION

If you have rough, scaly, or persistent lesions on sun-exposed skin:

📞 Call (847) 518-9999