Actinic keratoses (AKs) are rough, scaly patches caused by years of sun exposure. They are considered precancerous — each untreated AK carries a risk of progressing to squamous cell carcinoma (SCC). At Belaray Dermatology (Hicksville and Stony Brook, Long Island), our board-certified dermatologists diagnose and treat AKs using both spot and field therapies guided by the severity of your UV damage.
What Do Actinic Keratoses Look Like?
- Rough, dry, scaly patch — often easier to feel (sandpaper texture) than see
- Flat-to-slightly raised patch, usually less than 2.5cm
- Pink, red, or brownish color on sun-exposed areas (scalp, face, ears, lips, forearms, hands)
- Itching, burning, or tenderness in the patch
- Hard, wart-like surface in some cases (hypertrophic AK)
Treatment Options
Cryotherapy (Liquid Nitrogen)
Freezing individual AKs with liquid nitrogen is the most common spot treatment. The lesion blisters and peels away over 1–2 weeks. Highly effective for isolated, well-defined AKs.
Field Treatment (for Widespread Damage)
- 5-Fluorouracil (Efudex, Tolak) — topical chemotherapy cream applied for 2–4 weeks; targets subclinical AKs not yet visible
- Imiquimod (Zyclara, Aldara) — immune modulator; stimulates local immune response to clear AKs
- Diclofenac 3% gel (Solaraze) — anti-inflammatory topical; used for thinner or less extensive AKs
Photodynamic Therapy (PDT)
Aminolevulinic acid (ALA) is applied to the skin and activated by a specific wavelength of light. Highly effective for field treatment of widespread AKs. One or two sessions clear extensive photodamage.
AKs and Skin Cancer Risk
The presence of AKs indicates broader field damage — subclinical pre-cancerous cells exist beyond visible spots. Field treatment is often preferred over spot-only cryotherapy for patients with diffuse photodamage.
Belaray has three dual board-certified Mohs surgeons on staff. If an AK progresses to SCC, the same practice provides definitive surgical treatment — continuity of care from prevention through treatment.
Frequently Asked Questions
Are actinic keratoses cancer?
AKs are precancerous, not cancer. They are squamous cell carcinoma in situ — abnormal cells confined to the outer skin layer. Untreated, some progress to invasive SCC. Treatment at the AK stage prevents this progression.
How long does cryotherapy take for AKs?
Cryotherapy is a brief in-office procedure — each spot is frozen for 5–15 seconds. Most patients have multiple spots treated in a single 10–15 minute visit.
Can actinic keratoses come back after treatment?
Yes. Clearing existing AKs does not prevent new ones from forming in sun-damaged skin. Annual skin exams, year-round sun protection, and periodic field treatment are needed for long-term management.
Do I need a referral to see a dermatologist for AKs?
Most insurance plans allow direct access to dermatologists without a referral. Some HMO plans require a PCP referral. Belaray accepts most major insurance plans — call to verify before scheduling.
Schedule at Belaray Dermatology
Hicksville and Stony Brook, Long Island. Most major insurance accepted.
📅 Book Online 💬 Text (516) 822-7546Medical References
Belaray Dermatology education articles are written by our clinical team and medically reviewed by our physicians. This article draws on guidance from the following authoritative sources:
- American Academy of Dermatology — Skin cancer overview, detection, and self-exams.
- American Cancer Society — Skin cancer facts and statistics.
- Skin Cancer Foundation — Prevention, early detection, and treatment.