Patient information · Dermatology
Sun damage and actinic keratosis
rough patches that are easier felt than seen
Actinic keratoses are rough, scaly patches on skin that has had years of sun exposure. They are pre-cancerous — a small proportion progress to squamous cell carcinoma — and they are usually easier to feel than to see, like sandpaper under the fingertips.
Have a lesion checked promptly if it is
- growing, thickening or becoming lumpy
- tender, painful or itchy
- bleeding or ulcerating
- developing a hard horn-like projection
- not healing within four weeks
- a new pigmented or changing mole nearby
An actinic keratosis that becomes thickened, tender, ulcerated or rapidly growing may have progressed to a squamous cell carcinoma, which needs urgent assessment. Any non-healing lesion on sun-exposed skin should be examined rather than watched.
Recognising them
- Rough, dry, scaly patches, usually a few millimetres to a centimetre
- pink, red, brown or skin-coloured, sometimes with a white or yellowish crust
- Often felt before seen — run your fingers over the area
- on the face, scalp (especially if balding), ears, backs of the hands, forearms and lower legs
- typically multiple, on a background of general sun damage — freckling, thinning, broken capillaries
- they may come and go, becoming more prominent in summer
Who gets them
- fair skin that burns easily, particularly with red or blonde hair
- age over 50, and considerably more common with each decade after
- cumulative lifetime sun exposure — outdoor work, sport, sunbeds, living abroad
- immunosuppression — particularly after organ transplant, where lesions are more numerous and more likely to progress
- previous skin cancer
How likely are they to become cancer?
The risk for any individual lesion is low — roughly one in a thousand per year. But people rarely have one; they have twenty or fifty, over many years, which is why the cumulative risk is meaningful. The field of sun-damaged skin matters more than any single patch. That is why treatment often targets an entire area rather than picking off individual spots, and why regular self-checking is part of the plan.
Treatment options
- Cryotherapy — freezing individual lesions with liquid nitrogen. Quick, done in clinic, causes a blister and sometimes a pale mark afterwards. Best for a few discrete patches.
- Topical field treatments — creams applied over a whole affected area for a defined period. They cause marked redness, crusting and soreness while working, which is expected and is the treatment doing its job. People often stop early; finishing the course is what determines the result.
- Photodynamic therapy — a light-activated cream, effective for larger areas with good cosmetic outcome.
- Curettage or excision for thickened lesions, or where cancer needs excluding with a specimen.
- Observation is reasonable for a small number of thin, asymptomatic lesions with regular review.
Preventing more
Do
- SPF 50 daily on face, ears, scalp and hands — all year, not just on holiday
- A wide-brimmed hat; a cap leaves the ears and neck exposed
- Long sleeves and UV-protective clothing for outdoor work
- Shade between 11am and 3pm
- Check your own skin monthly, and have a professional check if you have many lesions
Avoid
- Sunbeds entirely
- Assuming a cloudy day means no UV
- Neglecting the scalp if hair is thinning
- Picking or scratching lesions
- Waiting for a lesion to become painful before having it checked
If you have had a transplant
People on long-term immunosuppression after organ transplant develop actinic keratoses and skin cancers far more frequently, earlier, and with a higher rate of progression. Annual specialist skin surveillance is recommended, and rigorous sun protection matters more here than in almost any other group. If nobody has arranged this for you, ask.
Why come to us. Rough patches on sun-exposed skin are easy to ignore for years and straightforward to treat. Our dermatology team examines the whole field rather than a single spot, distinguishes actinic keratoses from early skin cancer, and treats them here — cryotherapy in clinic, prescription field treatments not available over the counter, and minor surgery with specimens sent for analysis. Dermoscopic mole checks are available in the same appointment. Seven days a week, published fees.
Field assessed, treated in clinic the same visit
Cryotherapy and minor surgery on site, published fees.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.