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Health & Medicine for Senior Citizens

Actinic Keratosis – Dry Scaly Skin Spots Common for Seniors – Can Lead to Cancer

For up to 10 percent of people, AKs – off-color skin blemishes often referred to as “sun spots” - will progress to squamous cell carcinoma.

By Dr. Ellen Marmur

Photo of one actinic keratosis from the website Spot the Signs. See more below

March 19, 2013 - We all know someone who fits the bill: fair-skinned, covered in “sun spots” after having spent their younger days soaking up the sun, getting a nice bronze tan (or sunburn) while unwittingly bathing themselves in the sun’s harmful UV rays. While education around skin cancer has increased dramatically, it doesn’t help the generations of sun-worshippers for whom the damage has already been done. I know, because I am an ex sun worshipper who has survived skin cancer. For these people, proactive skin care and screening is essential.

One of the most common, but also most unknown pre-cancers of the skin, is actinic keratosis (AK). When I ask people if they know what actinic keratosis is, I often get the same exact answer, “I’ve never heard of it.” This is somewhat alarming given the fact that these precancerous spots are the third most frequently diagnosed skin problem - affecting upwards of 58 million Americans.

As a dermatologist, I am proud of and happy about all of the education we have seen around melanoma and skin cancer protection. However, one area where we have not seen enough education is the treatment of pre-cancers such as AK. It is important because, despite the fact that most AKs remain benign, approximately 5-10 percent develop into squamous cell carcinoma within an average of two years.[1]

 So what are AKs? Actinic keratosis is a precancerous skin condition that is often mistaken for sun spots and is typically diagnosed in older adults. AKs are the result of years of cumulative sun damage and are most prevalent in older adults who have spent a lot of time in the sun over the course of their lives.  

Spot Signs of AK

What do AKs look like?

AKs generally begin as rough spots of skin that may be easier felt than seen. Common complaints include a lesion that has increased in size or one that is raised, bleeding, poor in healing, discolored or associated with discomfort such as pain or itching.

While a lesion may initially appear skin-colored to pink, red, or brown, lesions on darker skin may be more pigmented. AKs may feel soft, rough or “gritty,” but in any case, they feel different from the surrounding healthy skin.

Since there are many clinical variants of AKs, it is best to consult a dermatologist if you suspect a lesion.

Dr. Marmur is working with DUSA Pharmaceuticals to support a non-branded disease awareness campaign “Spot the Signs.” The web site has facts on AKs, photos of AK lesions and commonly asked questions.

AKs most often appear on parts of the body that are regularly exposed to sunlight such as the face, scalp, ears, neck, hands and arms. They are also more common in people with fair skin, so if you’re one of those people you should be on particularly high alert.

AKs are rough-textured, dry, scaly patches on the skin that can range in color and vary in size. It is not typical for the sun to affect only small patches of the skin – therefore, people who are diagnosed with an AK will typically develop more AKs. So while there may be one AK on the surface, there may be more nascent AKs that will present over time.

Since there is no way to know ahead of time which AKs will become cancerous, it is very important to seek a dermatologist’s care. Don’t ignore your sun spots! Frequent skin examinations are the key to early detection and prevention. If you think you have AKs you should see your dermatologist and talk about the best treatment options.

There are many treatment options available, and you should discuss which is best for you with your dermatologist. These treatments include:

       Photodynamic Therapy
This treatment involves the application of a photosensitizing agent to the AKs. The treated area is exposed to a light that activates the agent. The period between application and exposure will vary and depend on the photosensitizing agent that is used. This treatment targets just the AKs and causes little damage to the surrounding normal tissue. Some redness, swelling and a burning sensation during therapy often occurs.


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       Cryotherapy (freezing)
This treatment involves freezing the AKs with an extremely cold substance such as liquid nitrogen. There is no cutting or anesthesia required. This method causes the lesion(s) to shrink or become crusted and then fall off. After treatment there may be temporary redness and swelling. In some patients this treatment can cause permanent white spots on the skin.

       Topical Medication
This treatment involves the application of a topical medication to the affected skin. The course of treatment can range from days to weeks, depending on the topical medication that is used. Redness, swelling and ulceration may occur during treatment.

       Curettage (scraping)
This procedure involves the use of a curette to scrape off cells that are damaged. A local anesthetic is required for this procedure. Scarring and skin discoloration may occur at the site of the treatment.

       Chemical Peel
Chemicals are applied directly to the AKs. The chemical causes the top layer of skin to slough off. This layer of skin is usually replaced within seven days. Anesthesia is necessary for this procedure and temporary discoloration and irritation can occur.

This procedure involves using a rapidly moving brush to remove the affected skin. Local anesthesia is used. Following the procedure, the skin appears red and raw-looking. It can take as long as several months for the treated area to heal.

       Surgical Excision
With surgical excision, the entire lesion with some healthy tissue is removed. Scarring is possible with this procedure.

This treatment involves focusing a laser on the lesion. The laser cuts through the skin tissue without causing bleeding. Local anesthesia may be required. This treatment can cause pigment loss in the skin.

As always, it is imperative to talk to your dermatologist if you think you have AKs, but if you’d like to learn more, please visit This site has a variety of educational tools including a list of signs, prevention advice, and treatment options. It can even help you find a nearby dermatologist.

[1] Fuchs A., Marmur E. The Kinetics of Skin Cancer: Progression of Actinic Keratosis to Squamous Cell Carcinoma. Dermatol Surg. 2007:33;1099-1101.

About Dr. Ellen Marmur

Dr. Ellen Marmur is an Associate Professor of both the Department of Dermatology and Department of Genetics & Genomic Research, and was promoted to Vice Chair, Cosmetic and Dermatologic Surgery in 2011 after having been the first woman Chief of Dermatologic and Cosmetic Surgery at The Mount Sinai Medical Center in New York City for 7 years.


A board-certified dermatologist with advanced, fellowship training in cosmetic & laser surgery as well as Mohs skin cancer surgery, Dr. Marmur earned her degree in medicine at Albert Einstein College of Medicine with distinction in research on melanoma vaccines and the Alpha Omega Alpha award for overall academic and clinical excellence in medicine. She trained in internal medicine at Mount Sinai School of Medicine and then in dermatology at The New York-Presbyterian Weill Cornell Hospital in Manhattan.

Dr. Marmur completed her fellowship in Mohs Micrographic surgery & Cosmetic Surgery with the world reknowned leader, Dr. David Goldberg. Dr. Marmur is the principle investigator on dozens of research studies including FDA trials on new therapies such as the safety trial using calcium hydroxyapatite filler in dark skin types, the first in class treatment of advanced basal cell carcinoma approved in 2012 called Erivedge, and many new treatments for actinic keratoses. Her current interest is in genomic and epigenetic analysis of the effects of sun exposure and aging on skin.


Dr. Marmur’s passion is to understand how healthy skin protects against skin cancer and aging.

Member of Professional Organizations

Dr. Marmur is President of the American Society of Cosmetic Dermatology & Aesthetic Surgery (ASCDAS), a spokesperson for the American Academy of Dermatology, an active member of the American Society of Dermatologic Surgery, The New York Dermatologic Society, Women’s Dermatologic Society, American Medical Women’s Association, American College of Mohs Micrographic Surgery and Cutaneous Oncology, and American Society for Laser Medicine and Surgery.

For more information on Dr. Marmur, visit


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