Solar keratosis – what is it and is it dangerous?

Content author: MD. Piotr Rak, surgeon · Editorial work: Editorial team of Wyspa Medycyny Przyjaznej · Medical review: lek. Piotr Rak · Date of creation: 07.08.2026 · Date of review: 07.08.2026 · Updated: 07.08.2026

The article is of educational nature and does not replace skin examination or dermatoscopic assessment. A lesion that grows rapidly, hardens, forms a lump, bleeds, ulcerates, hurts, itches or does not heal for several weeks requires urgent medical evaluation - skin lesions cannot be diagnosed based on photos found on the Internet.

The most important information at a glance

• Actinic keratosis, also called actinic keratosis, is a skin lesion resulting from long-term exposure to UV radiation.
• It is not cancer, but it is a pre-cancerous lesion. Some lesions may, over time, develop into squamous cell carcinoma of the skin.
• It is impossible to predict which specific lesion will change - so the changes are treated rather than observed indefinitely.
• Characteristic is a rough, rough surface. Change is often easier to feel than to see.
• Typical locations include the forehead, nose, auricles, scalp in balding people, lips, forearms and backs of hands.
• Risk factors include fair skin, age, outdoor work or hobbies, history of sunburn, tanning beds and reduced immunity.
• The presence of multiple lesions in one area indicates damage to the entire area, not just individual spots.
• Treatment methods include cryotherapy, removal of the lesion, local treatment and photodynamic therapy.
• Treatment does not end the matter: regular skin monitoring and consistent photoprotection are necessary afterwards.
• A lesion that is hardening, painful, bleeding or growing rapidly may already be cancerous and requires urgent evaluation, not another ointment.

Find out more about the specialist

Doctor. Piotr Rak is a surgeon at the Island of Friendly Medicine in Gdańsk. He deals with surgical procedures, including the assessment and removal of skin lesions. In actinic keratosis, the most important thing is to distinguish a pre-cancerous lesion from a skin cancer and to evaluate the entire area damaged by the sun, not just a single lesion noticed by the patient.

Schedule a consultation

What is solar keratosis?

Solar keratosis is the result of cumulative doses of ultraviolet radiation throughout life. UV damages the genetic material of keratinocytes, i.e. epidermal cells. The body has repair mechanisms, but with repeated exposure some damage remains unrepaired and accumulates for decades.

As a result, cells with abnormal structure and impaired keratinization appear in the epidermis. A patch of rough, flaky skin develops - sometimes barely visible, but felt under the fingers like fine sandpaper.

One feature is key: abnormal cells remain within the epidermis and do not cross its border. Therefore, keratosis is not yet cancer. However, when the lesions exceed this limit and begin to infiltrate deeper, we are talking about squamous cell carcinoma of the skin.

For this reason, actinic keratosis is referred to as a precancerous lesion - it is a stage on a path that leads further in some patients and stops in place in others.

What does it look like and where does it occur?

Typical actinic keratosis is a flat or slightly raised lesion ranging from a few millimeters to about a centimeter in diameter, covered with a dry, adherent scale. The color varies: flesh-colored, pink, reddish, yellowish or brown. The surface is rough and rough.

In practice, one observation is the most characteristic: change is often easier to feel than to see. Patients describe that when shaving or applying cream, their fingers stop on a rough spot that is almost invisible to the naked eye. It also happens that the scales come off and after a few weeks they reappear in the same place - this is a typical course and does not mean cure.

Locations correspond to the places most exposed to the sun over the years:

• forehead, temples, nose and cheeks,
• earlobes, especially in men,
• scalp in balding people,
• redness of the lower lip - a form called cheilitis associated with sun,
• neck and cleavage,
• forearms and backs of hands,
• in women also lower legs.

Lesions rarely occur singly. There are usually several or a dozen of them in one area, and between them the skin may be unevenly colored, thin and with visible capillaries. This condition is described as damage to the entire skin area - and this has a direct impact on the method of treatment.

Is solar keratosis dangerous?

This is a question from the title and deserves an answer without evasion, both ways.

There is no need to panic. Single keratosis is not cancer, does not metastasize and is not life-threatening. Some changes go away on their own, especially when the patient begins to consistently protect the skin from the sun.

There is no reason to be dismissive either. The risk of a single lesion transforming into squamous cell carcinoma is small but real - and increases with the number of lesions, their duration and with reduced immunity. A patient with several outbreaks has a much higher overall risk than a patient with one.

The heart of the problem lies elsewhere: we cannot predict which specific change will occur. There is no feature to indicate it in advance. That is why dermatology adopts a practical approach - lesions are treated rather than observed for years and waiting for one to become problematic.

There is a second, often overlooked consequence of diagnosis. The presence of actinic keratosis is a signal that the patient's skin has received a significant, cumulative dose of UV radiation. This also increases the risk of other skin cancers in other locations - so the diagnosis of keratosis is a good time to examine the entire skin, and not just to remove one focus.

When does a change require urgent assessment?

Some features suggest that we are no longer dealing with keratosis, but with skin cancer. A lesion that:

• grows rapidly within weeks
• hardens or forms a noticeable lump
• becomes ulcerated or does not heal for several weeks
• bleeds without any obvious trauma
• begins to hurt or is tender to touch
• persistent itching or burning,
• has uneven, blurred borders or irregular color,
• does not respond to previous treatment or recurs quickly in the same place,
• is located on the lip, eyelid or earlobe,
• appeared in a person with a weakened immune system or after an organ transplant.

The last two situations require special vigilance. Lesions on the lip and ear have a less favorable course, and in patients after organ transplantation who take immunosuppressive drugs, actinic keratosis is more common and is more likely to turn into cancer.

What is it sometimes confused with?

Several skin lesions look similar but have a completely different meaning. This is the main reason why a rough spot should not be assessed on its own or "treated" with a moisturizing cream for the following months.

The basis for diagnosis is a clinical examination with dermatoscopic evaluation. In doubtful cases, with atypical lesions or those not responding to treatment, a biopsy and histopathological examination are performed.

Who is at risk?

• people with fair skin, light or red hair that burns easily and tans difficult,
• people over 50, although changes also appear earlier,
• people working outdoors: construction workers, farmers, gardeners, fishermen, athletes,
• people with numerous burns sun exposure in the past, especially in childhood,
• using solariums,
• patients after organ transplantation and taking immunosuppressive drugs,
• people with previously diagnosed skin cancer,
• taking drugs that increase the skin's sensitivity to light,
• balding men - uncovered scalp is particularly exposed.

It is worth emphasizing that the sum of exposure over a lifetime is decisive, not one trip to the seaside. Everyday, seemingly harmless doses of UV - commuting to work, gardening, walking the dog - add up over decades. Therefore, changes appear in people who have never considered themselves "tanning".

Treatment methods

Treatment is selected depending on the number of lesions, their location, thickness, patient's age, comorbidities and whether a single lesion or the entire skin area is damaged.

It is worth paying attention to the distinction in the second and third position. When there are many lesions, treatment of visible lesions alone may be insufficient, because the surrounding skin has lesions at an early stage, not yet noticeable. Then it makes more sense to treat the entire area - this approach is called damaged area treatment.

In the case of local and photodynamic treatment, the patient must be warned about the expected reactions: redness, burning, erosions and scabs during the therapy. This is not a complication, just an expected course - but it can be so pronounced that an unwary patient stops the treatment halfway through. The specific method, preparation and duration of use are determined by the doctor during qualification.

What happens after treatment? Photoprotection and control

Removing the changes does not remove the cause. Skin that has accumulated decades of UV exposure remains higher-risk skin - so post-treatment management is just as important as the treatment itself.

• Cream with high SPF every day, on exposed skin, all year round - not only in summer and not only on the beach.
• Reapply every few hours when outdoors and after sweating and bathing.
• Wide-brimmed headgear, which also covers the ears and neck - a baseball cap does not.
• Long-sleeved clothing for long periods of work outdoors.
• Avoiding the sun during peak sun hours, usually between 11 a.m. and 4 p.m.
• Avoiding tanning beds - no exceptions.
• Lip protection with a lipstick with a filter, especially when working outdoors.
• Skin self-observation and reporting any new rough, non-healing or changing areas.
• Regular check-ups with a doctor at individually determined intervals, depending on the number of lesions and risk factors.

Recurrences in the same area are common and do not mean that the treatment was ineffective. They mean that the skin in this place is permanently damaged and requires constant supervision.

What not to do on your own

• do not scrape or remove the scale - the lesion grows back and irritated skin makes subsequent assessment difficult,
• do not use burn preparations, acids or "wart" products purchased without consultation,
• do not order prescription preparations for this indication online,
• do not assume that a rough spot is simply dryness and do not treat it with a moisturizing cream for months,
• do not use steroid ointments without recommendation,
• do not remove lesions in offices where no one assesses them medically or performs dermatoscopy,
• do not compare your own lesion with photos from the Internet instead visit,
• do not postpone the consultation when the lesion hardens, bleeds or does not heal.

The most common myths

• "It's just dry skin." No. Keratosis does not go away with moisturizer and persists or recurs in the same place.
• "It's cancer." No. It is a precancerous lesion that may develop in some patients - but it is not cancer itself.
• "If it doesn't hurt, you can wait." NO. Keratosis usually does not hurt. The appearance of pain is a warning sign rather than a requirement for treatment.
• "The scales are gone, so it's cured." No. The scale often comes off and grows back - this is a typical course, not a cure.
• "Only applies to people who have sunbathed." No. The sum of exposures throughout life, including everyday and accidental ones, is decisive.
• "The filter only needs to be used in summer." No. UVA radiation is active all year round, even when it is cloudy.
• "Since the change has been removed, case closed." No. The skin remains damaged and requires control and photoprotection.
• "The solarium is safer than the sun." No. Solarium increases the risk of skin lesions and skin cancer.

Do you have a rough, flaky patch that won't go away?

Actinic keratosis is best treated early. During the consultation, we will assess the lesion and the entire area and select a method appropriate to the number and thickness of the lesions.

Diagnostics and treatment of skin lesions in the Island of Friendly Medicine in Gdańsk

In the Island of Friendly Medicine doctor. Piotr Rak consults patients with skin lesions that require evaluation and possible removal. In the case of actinic keratosis, the visit includes examination of the lesion, dermatoscopic assessment, inspection of the sun-damaged area and discussion of the treatment method appropriate to the number and nature of the lesions.

If the image raises suspicion of skin cancer, the lesion is removed with histopathological examination or the patient is referred for further diagnostics. The current scope of treatments, availability of dates and prices should be confirmed during registration.

Make an appointment Dermatoscopy

What to ask the doctor?

• Is my lesion really solar keratosis?
• Do I need a dermatoscopy or biopsy?
• How many such changes do I have and are there any spots that I haven't noticed myself?
• Is it enough to treat individual lesions or the entire area in my case?
• What method do you propose and why this one?
• What will the skin look like during and after treatment?
• How long does the treatment take and will it need to be repeated?
• Can the change come back in the same place?
• Should I have my whole skin looked at?
• Which filter should I use and how often should I apply it?
• What should I worry about between visits?
• When should I go for a check-up?

FAQ - solar keratosis

What is solar keratosis?

This is a skin lesion resulting from long-term exposure to UV radiation. It appears as a rough, scaly patch on sun-exposed skin. Abnormal cells remain within the epidermis.

Is it cancer?

No. Actinic keratosis is a pre-cancerous lesion. Some lesions may develop into squamous cell carcinoma of the skin over time, but the lesion itself is not cancer.

Does it need to be treated?

Yes, because it is impossible to predict which change will transform. The treatment is simple and effective, especially in the early stages, so you do not have to wait for years.

How to recognize keratosis?

The surface is rough - the change is often easier to feel than to see. It occurs on sun-exposed skin and usually does not hurt. The diagnosis is made by a doctor after examination and dermatoscopic evaluation.

Can it disappear on its own?

Some lesions disappear on their own, especially with consistent sun protection. However, many persist or recur, and the scales coming off and growing back do not mean a cure.

What are the treatment methods?

Cryotherapy, local treatment with prescription drugs, photodynamic therapy, curettage and surgical excision in suspected cancer. The method is selected by the doctor depending on the number, thickness and location of the lesions.

What is damaged field treatment?

This is a treatment for the entire skin area, not just visible lesions. They are used when there are many lesions, because there are changes in the surrounding skin at an early stage, which are not yet visible and imperceptible.

Is the treatment painful?

Treatments are performed in a manner adapted to the method, if necessary under local anesthesia. In case of local and photodynamic treatment, the following reactions are expected: redness, burning and crusting. This is an expected course, not a complication.

Will the changes come back?

Relapses in the same area are common because the skin remains permanently damaged by years of UV exposure. They do not indicate the ineffectiveness of the treatment, but require constant monitoring and photoprotection.

When should I report urgently?

When the lesion grows quickly, hardens, forms a lump, bleeds, sores, hurts or does not heal for several weeks. Lesions on the lip and ear, as well as in people with weakened immunity, require special vigilance.

How to protect your skin after treatment?

Use a cream with a high SPF every day all year round, wear a wide-brimmed hat, avoid the sun during peak sun hours, avoid tanning beds and check your skin regularly.

Who assesses skin lesions in WMP?

On the WMP website, MD. Piotr Rak is described as a surgeon who performs surgical procedures, including the evaluation and removal of skin lesions. The scope and availability of treatments are confirmed by registration.

Sources

• DermNet, Actinic keratosis: https://dermnetnz.org/topics/actinic-keratosis
• DermNet, Cutaneous squamous cell carcinoma: https://dermnetnz.org/topics/squamous-cell-carcinoma
• DermNet, Basal cell carcinoma: https://dermnetnz.org/topics/basal-cell-carcinoma
• NHS, Actinic keratoses (solar keratoses): https://www.nhs.uk/conditions/actinic-keratoses/
• NHS, Skin cancer (non-melanoma): https://www.nhs.uk/conditions/non-melanoma-skin-cancer/
• NHS, Sunscreen and sun safety: https://www.nhs.uk/live-well/seasonal-health/sunscreen-and-sun-safety/
• NICE, Suspected cancer: recognition and referral (NG12): https://www.nice.org.uk/guidance/ng12
• British Association of Dermatologists, information for patients: https://www.bad.org.uk/patient-information-leaflets/
• World Health Organization, Ultraviolet radiation: https://www.who.int/news-room/questions-and-answers/item/radiation-ultraviolet-(uv)