A rough, scaly patch on the face, scalp or forearm can be easy to dismiss as dry skin. But actinic keratosis is a sign that ultraviolet (UV) exposure has damaged skin cells, and it deserves clinical attention. In Australia, where UV levels can be high even outside summer, acting early can help prevent a more serious skin cancer from being missed.

Actinic keratoses are common, particularly in people who have spent years working, exercising or enjoying time outdoors. They are usually treatable, but a diagnosis should not be made from appearance alone. A skin check gives a doctor the opportunity to examine the spot closely and assess the rest of your sun-exposed skin at the same time.

What does actinic keratosis look and feel like?

An actinic keratosis, sometimes called a solar keratosis, often appears on areas repeatedly exposed to the sun. This includes the ears, nose, cheeks, lips, bald or thinning scalp, neck, backs of the hands and forearms.

It may look red, pink, skin-coloured or brown. The surface is often dry, crusty or sandpapery, and some spots are felt before they are easily seen. A lesion may sting, itch, bleed after being rubbed, or return in the same place after seeming to settle.

Not every rough patch is actinic keratosis. Eczema, warts, benign growths and several forms of skin cancer can look similar. That is why a persistent, changing or bleeding spot should be assessed rather than treated repeatedly with moisturiser or over-the-counter creams.

Why actinic keratosis should not be ignored

Actinic keratosis is caused by cumulative UV damage. It is considered a precancerous skin change because some lesions can develop into squamous cell carcinoma, a common type of skin cancer. It is not possible to tell with certainty which individual spot will progress.

The risk is not only about one visible lesion. Multiple actinic keratoses can indicate broader sun damage across an area of skin, sometimes called field damage. This can mean there are early abnormal cells beyond the spots you can see or feel.

Prompt review is especially important if a lesion becomes tender, thickened, rapidly grows, forms a persistent crust or ulcer, or starts bleeding. These changes do not automatically mean cancer, but every minute counts when a suspicious lesion needs diagnosis and treatment.

Who is more likely to develop it?

Anyone can develop sun damage, but actinic keratoses are more common with age and after long-term UV exposure. Risk is higher for people with fair skin, a history of frequent sunburn, outdoor work or recreation, previous skin cancers, or a weakened immune system.

People with darker skin tones can also develop sun-related skin damage and skin cancer. Do not assume you are protected because you tan easily or have not burned often. Any new, changing, painful or non-healing lesion warrants medical advice.

Australians who work outdoors, including tradies, farmers, landscapers, lifeguards and road crews, may have substantial cumulative exposure even when they use sun protection. So can regular golfers, fishers, runners and beachgoers. The face, ears and scalp are often missed during quick sunscreen application.

How is actinic keratosis treated?

A GP, dermatologist or qualified skin cancer clinician may diagnose actinic keratosis by examining your skin with a dermatoscope. If the diagnosis is uncertain, or the lesion has concerning features, a biopsy may be needed.

Treatment depends on the number, location and thickness of lesions, as well as your medical history. A single spot may be frozen with liquid nitrogen. Where there are many lesions or widespread field damage, a clinician may recommend a prescription cream, gel or solution, photodynamic therapy, or another procedure. These treatments can cause temporary redness, crusting or inflammation because they are targeting damaged cells.

Do not pick, scrape or attempt to burn off a suspected lesion at home. Removing the surface does not establish what it is, and can delay the assessment of a skin cancer.

Reduce further UV damage

Treatment clears existing lesions but cannot erase past sun exposure or stop new ones from forming. Daily protection remains part of ongoing care: use broad-spectrum, water-resistant SPF 50+ sunscreen, wear protective clothing and a broad-brimmed hat, seek shade, and reapply sunscreen as directed. Check the UV Index and protect your skin whenever it is 3 or above.

If you have had actinic keratoses, ask your clinician how often you should have a professional skin check. The right interval varies according to your skin type, sun exposure, number of lesions and personal history of skin cancer.

A rough patch may be harmless, but guessing is not a safe plan. Book a skin check for anything persistent or changing – early assessment can protect more than one small area of skin.