Rough, scaly patch
A dry, sandpapery spot you can often feel more easily than you can see it.
Medical Dermatology
Actinic keratoses (precancerous spots)
Rough, scaly spots on sun-exposed skin are often actinic keratoses — the most common precancer. Treating them early is a simple, effective way to stay ahead of skin cancer.
Overview
Understanding actinic keratoses
Actinic keratoses (AKs) are dry, rough, scaly patches that form on skin with years of sun exposure — typically the face, scalp, ears, lips, forearms, and the backs of the hands. They're often easier to feel than to see: a persistent sandpapery spot that doesn't smooth out. They can be skin-colored, pink, red, or brown, and there are frequently several at once in sun-damaged areas.
AKs matter because they're considered precancerous. Left untreated, a small percentage can progress to squamous cell carcinoma, a common skin cancer — and because there's no way to predict which ones will, dermatologists treat them proactively. The good news: caught early, they're quick and straightforward to treat, which is exactly why we'd rather address them now than wait.
Here in sunny, high-elevation Central Oregon, sun damage adds up faster than many people expect — UV exposure is stronger at altitude, year-round. If you've noticed rough spots that come and go or never quite heal, it's worth having them checked. We treat the spots you have and help protect the skin around them going forward.
Why we treat precancers early
Actinic keratoses are a warning sign worth acting on. Treating them early lets us:
- Remove precancerous cells before any can progress to squamous cell carcinoma.
- Treat not just visible spots but the surrounding sun-damaged 'field' where new AKs tend to form.
- Take stock of your overall sun damage and skin-cancer risk while we're at it.
- Keep treatment quick and simple — early spots are far easier to handle than a skin cancer would be.
Signs a spot is more than sun damage
Most AKs respond well to treatment. Tell us right away about a spot that:
- Grows quickly, thickens, becomes tender, or develops into a firm bump.
- Bleeds, crusts, or won't heal — which can signal it has advanced beyond a simple AK.
- Turns into a rough, horn-like growth, or a sore that keeps returning in the same spot.
- Looks or feels different from your other spots — always worth a closer look.
Because actinic keratoses are precancers, they connect closely to our Skin Cancer Center and to routine skin cancer screening — and you can read more about skin cancer treatment.
Signs & symptoms
What we look for
Sun-exposed areas
Most common on the face, scalp, ears, lips, forearms, and backs of the hands.
Pink, red, or brown
Color varies — skin-colored, pink, red, or tan against sun-damaged skin.
Comes and goes
May flake off and seem to heal, then return in the same place.
Often several
Frequently appears as multiple spots in one sun-damaged area.
Sometimes tender
Can itch, sting, or feel tender — or cause no sensation at all.
How we treat it
Your treatment options
Treatment depends on how many spots you have and where they are. For a spot or two we treat directly; for widespread sun damage, we treat the whole area — and we'll recommend the right approach for you.
Cryotherapy
Freezing individual actinic keratoses with liquid nitrogen — quick, effective, and the go-to for a limited number of spots.
Field therapy
Prescription creams (such as 5-fluorouracil, imiquimod, or tirbanibulin) that treat both visible AKs and the surrounding sun-damaged skin where new ones form.
Photodynamic therapy (PDT)
A light-activated treatment that clears AKs across a broad area — well suited to the face and scalp with significant sun damage.
Curettage or biopsy
Scraping a thick or stubborn spot — and sending it to pathology if there's any concern it's more than an AK.
Ongoing skin checks
Because AKs signal sun damage, we keep an eye on the bigger picture with periodic skin cancer screenings.
Sun-protection plan
Practical guidance on sunscreen and sun habits — especially important at Central Oregon's elevation — to slow new AKs from forming.
When to come in
If you have rough, scaly spots on sun-exposed skin that won't smooth out or keep coming back, have them checked — actinic keratoses are easy to treat early and best not left alone. And any spot that grows, bleeds, thickens, or won't heal deserves prompt evaluation.
Schedule with JuniperCommon questions
Actinic Keratoses FAQ
What is an actinic keratosis?
An actinic keratosis (AK) is a rough, scaly patch that develops on skin damaged by years of sun exposure — commonly the face, scalp, ears, lips, forearms, and backs of the hands. It's considered precancerous, meaning a small percentage can develop into squamous cell carcinoma over time. Because we can't predict which ones will, dermatologists treat them early.
Are actinic keratoses skin cancer?
Not yet — they're precancerous. On their own, AKs are not skin cancer, but they're a marker of significant sun damage and a small percentage can progress to squamous cell carcinoma if left untreated. Treating them is a straightforward way to stay ahead of that risk, which is why we take them seriously.
How are actinic keratoses treated?
For a few spots, freezing them with cryotherapy (liquid nitrogen) is quick and effective. For widespread sun damage, we use 'field therapy' — prescription creams like 5-fluorouracil, imiquimod, or tirbanibulin — or photodynamic therapy (a light-activated treatment) to clear a broad area at once. Thick or suspicious spots may be scraped and sent to pathology. We'll match the approach to your skin.
Will actinic keratoses go away on their own?
Sometimes an AK flakes off and seems to disappear, but it often comes back in the same spot, and new ones tend to form in sun-damaged skin. Because they can slowly progress and are impossible to predict individually, the safest approach is to treat them rather than wait and watch a precancer.
How can I prevent actinic keratoses?
Sun protection is the key — daily broad-spectrum sunscreen, hats, protective clothing, and avoiding peak-intensity sun. This matters especially at Central Oregon's elevation, where UV is stronger year-round. Regular skin checks also help us catch and treat new spots early before they become a problem.
Bend & Redmond · Central Oregon
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