Actinic keratoses (AKs) are rough, scaly patches caused by years of sun exposure. They are precancers: most stay harmless, but some can turn into squamous cell carcinoma, a type of skin cancer. At Pensacola Dermatology we diagnose and treat actinic keratoses every day, and on the Gulf Coast, where the sun is strong most of the year, they are one of the most common reasons adults come to see us.
What Actinic Keratoses Look and Feel Like
AKs, also called solar keratoses, usually develop slowly on skin that gets the most sun: the face, scalp, ears, neck, lips, the backs of the hands and the forearms. They are often easier to feel than to see. Common signs include:
- A rough, dry patch that feels like sandpaper
- A flat or slightly raised spot that is skin-colored, pink, red or brown
- A thickened, crusty or wart-like area
- Itching, burning, stinging or tenderness
- A patch that seems to come and go, or that flakes and returns
Many people have several at once. If you have one, there are often others nearby that aren’t visible yet.
Who Gets Actinic Keratoses
The main cause is cumulative ultraviolet (UV) exposure from the sun or tanning beds. Your risk is higher if you:
- Are over 40
- Have fair skin, blonde or red hair, or light-colored eyes
- Have spent a lot of time in the sun without protection, at work or for fun
- Have a weakened immune system, such as after an organ transplant
Boating, fishing, golf, beach days and outdoor jobs make AKs common in Pensacola, Gulf Breeze, Navarre and Perdido Key.
Why Treat a Precancer?
Not every actinic keratosis becomes cancer, and no one can predict which ones will. Treating them early removes that risk and is simpler than treating skin cancer later. It also matters because an AK and an early squamous cell carcinoma can look alike. If a spot is thick, painful, bleeding or growing quickly, your provider may recommend a biopsy to rule out cancer.
How We Diagnose Actinic Keratoses
Most AKs are diagnosed during an exam. Your provider looks at and feels the spot, asks how long it has been there and whether it has changed, and checks the rest of your sun-exposed skin for others. A spot that is unusually thick, tender, fast-growing or bleeding may be sampled with a quick biopsy under local numbing and sent to a lab, so we know whether we are treating a precancer or an early skin cancer. The answer shapes the treatment plan.
Actinic Keratosis Treatment Options
The right option depends on how many spots you have, where they are, how thick they are and your overall health. At Pensacola Dermatology we offer:
Cryotherapy
The most common treatment. Your provider freezes each visible spot with liquid nitrogen. It takes seconds per spot, and the treated skin heals over a week or two. A small white mark may remain.
Electrodesiccation and Curettage
For thicker spots, the lesion is gently scraped away with an instrument called a curette, and your provider may treat the base to remove the remaining damaged tissue. New, healthy skin grows in as it heals.
Topical Chemotherapy
A prescription cream applied at home to an area of sun damage. It treats the visible spots and the early ones you can’t see yet. Expect temporary redness, crusting or swelling while it works.
Topical Immunotherapy
A cream that boosts your skin’s own immune response so it clears damaged cells. It is usually applied at home for several weeks, and temporary redness and swelling are possible.
Chemical Peels
An in-office procedure that removes the top layer of sun-damaged skin. It can help when AKs are spread across a wider area, such as the face. Read more about our chemical peels.
Many patients need a combination: freezing for a few thick spots, plus a cream for the surrounding sun-damaged skin.
After Treatment: Monitoring and Prevention
Treatment clears existing spots, but the sun damage behind them doesn’t go away, so new AKs can appear. That is why we recommend regular skin exams, often once a year or more if you have a history of AKs or skin cancer. Our skin cancer screening visits check for new precancers and for skin cancer at the same time.
At home, the best protection is daily sun safety:
- Use a broad-spectrum sunscreen with SPF 30 or higher, and reapply when you are outside
- Wear a wide-brimmed hat, sunglasses and protective clothing
- Avoid the midday sun and seek shade
- Skip tanning beds
Our Team
Dr. Amy Pote Watson is a medical and surgical dermatologist and a Pensacola native who founded Pensacola Dermatology in 2004. She is joined by Jennifer Matechik, PA-C, Rachel LeMaitre, PA-C, and Jonathan Adair, PA-C. If an AK turns out to be a skin cancer, our team can plan your skin cancer treatment too.
Frequently Asked Questions
Are actinic keratoses cancer?
No. They are precancers. Most never become cancer, but some can turn into squamous cell carcinoma, which is why we treat them.
Does treatment hurt?
Cryotherapy stings briefly, much like a cold pinch. Treatment creams can make the skin red and sore for a while. Your provider will tell you what to expect and how to stay comfortable.
Will my actinic keratoses come back?
A treated spot usually clears, but new ones can form on sun-damaged skin. Regular checkups catch them early.
Can I treat a rough spot with an over-the-counter product?
Moisturizer won’t clear an AK, and treating at home risks missing an early skin cancer. Have any rough spot that won’t go away checked by a dermatology provider.
Get Rough, Scaly Spots Checked in Pensacola
Pensacola Dermatology is at 4850 Grande Dr, Pensacola, FL 32504. Call (850) 477-4447 or text (850) 821-3369. For coverage questions, see Insurance & Billing.
Don’t wait on a spot that keeps coming back. Request an appointment with Pensacola Dermatology.