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For further information, see CMDT Part 6-18: Miscellaneous Scaling Dermatoses

Key Features

  • Actinic keratoses are considered premalignant, but only 1:1000 lesions/year progresses to become squamous cell carcinoma

Clinical Findings

  • Actinic keratoses are small (0.2–0.6 cm) macules or papules—flesh-colored, pink, or slightly hyperpigmented—that feel like sandpaper and are tender to palpation

  • They occur on sun-exposed parts of the body in persons of fair complexion


  • Clinical

  • Differential diagnosis

    • Squamous cell carcinoma

    • Bowen disease (squamous cell carcinoma in situ)

    • Nonpigmented seborrheic keratosis

    • Psoriasis

    • Seborrheic dermatitis

    • Seborrheic keratosis

    • Paget disease


  • Liquid nitrogen

    • Rapid method of eradication

    • Lesions crust and disappear in 10–14 days

  • Field treatment

    • Defined as treatment over an area, rather than targeted treatment to one lesion

    • Can be considered in patients with multiple lesions in one region

    • Fluorouracil cream is the most effective topical agent

    • Imiquimod, ingenol mebutate, and photodynamic therapy are also effective

  • Lesions that persist should be evaluated for possible biopsy

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