Solar keratosis

A solar keratosis - also called an actinic keratosis, or a sunspot - is a rough, scaly patch that develops on skin with years of sun exposure. They are most common on the face, scalp (particularly where hair has thinned), ears, forearms, backs of the hands and lower legs.

This is a medical condition, not a cosmetic one. A solar keratosis is a precancerous lesion: the cells are already abnormal, and a proportion progress to squamous cell carcinoma if left. That is why this page reads differently from the cosmetic pages on this site.

What they look and feel like

• Rough, dry or scaly to the touch - often easier to feel than to see
• A few millimetres to a centimetre or so across
• Skin-coloured, pink, red or brown
• Sometimes tender, itchy or prickly
• They may crust, flake off and come back in the same spot
• Often multiple, on a background of generally sun-damaged skin

People who have one usually have several, and the skin around them is typically damaged too. This is why treatment is sometimes directed at the whole affected area (field treatment) rather than just the visible spots.

Who is most affected

• Fair skin that burns easily
• Long-term outdoor work or recreation, common in Australia
• Age over 40, with prevalence rising steadily after that
• A history of sunburn or solarium use
• Immunosuppression, including after organ transplant - a significantly higher risk group
• Previous skin cancers or previous keratoses

When to have a lesion checked promptly

Any of the following on or near a keratosis warrants medical assessment without waiting:

• Thickening, becoming lumpy or firm
• Rapid growth
• Tenderness or pain
• Bleeding
• Ulceration or a sore that does not heal
• A lesion that keeps recurring after treatment

These can indicate progression to squamous cell carcinoma. A lesion with those features is biopsied or excised and sent to pathology - not destroyed by laser or freezing, because destructive treatment leaves nothing to examine.

Assessment

Your skin is examined, including the surrounding area rather than only the spot that bothered you. Where the diagnosis is not clear, or where a lesion has worrying features, a biopsy or excision with pathology is the appropriate step.

Solar keratoses are also a marker: having them indicates the level of cumulative sun damage in your skin, and therefore an elevated risk of skin cancer generally. Ongoing skin checks are part of the plan.

Treatment

Individual lesions

• Cryotherapy - liquid nitrogen, the most common treatment for a discrete, clinically typical keratosis
• Curettage
• Surgical excision - where the diagnosis is uncertain or progression is suspected, so the tissue can be tested

Field treatment

Where there are many lesions across an area of sun-damaged skin:

• Photodynamic therapy
• Prescription topical treatments - these are prescription-only medicines, so they require a doctor's consultation and cannot be discussed by name in advertising
• Laser resurfacing in selected cases
• Chemical peels

What to expect after treatment

Cryotherapy typically causes stinging at the time, then redness, a blister and a scab that separates over one to three weeks, leaving a pink mark that fades. Field treatments produce a more visible inflammatory reaction across the treated area - redness, crusting and discomfort - which is expected and settles.

Keep the area clean, do not pick scabs, and protect the site from sun.

What results are realistic

Most solar keratoses clear with appropriate treatment. New ones commonly appear over time, because the underlying sun damage remains - so this is ongoing management rather than a one-off fix. Individual results vary.

Treatment reduces the risk associated with the lesions treated. It does not eliminate skin cancer risk, and it does not replace regular skin checks.

Risks

• Pain, redness, blistering and crusting
• Hypo-pigmentation - a permanent pale mark, common after cryotherapy
• Hyper-pigmentation
• Scarring
• Infection
• Delayed healing, particularly on the lower legs
• Incomplete treatment and recurrence
• Missed squamous cell carcinoma where a lesion is destroyed rather than examined

See risks and complications.

Prevention

• Broad-spectrum SPF 30 or higher daily on exposed skin
• Hat, sunglasses, long sleeves; shade in the middle of the day
• No solariums
• Regular skin checks, and prompt review of any changing lesion

Cost and Medicare

Because solar keratoses are a medical condition, assessment and treatment may attract a Medicare rebate where clinically indicated - unlike the cosmetic treatments elsewhere on this site. Me Clinic is not a no-gap provider, so an out-of-pocket cost will usually apply. You are quoted before treatment.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Related: sun damage, skin cancers, skin lesions, all skin conditions.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.