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Actinic (Solar) Keratosis

 

Introduction


AK should routinely be managed in primary care. 


Although less than 1/1000 AKs progress to SCC per annum, a patient with an average of 7 Aks has a 10% risk of one transforming in the next 10 years1.

 

In Scope:          

  • Actinic Keratosis

 

Not In Scope:

  • Skin Cancer

 

Red Flags

  • Rapidly growing lesions
  • Firm lesions with fleshy base and or are painful
  • Have thick scale (grade III AK)

 

*This list is not exhaustive

 

Primary Care Management

AK-Pathway-2025-Update-web.pdf


Important to stress skin cancer prevention to patient to prevent new lesions/SCC. E.G. Wearing high factor SPF.


Treatment of actinic keratosis does not result in reduction of progression to SCC2 but it will help highlight those not responding to normal therapy.

 

Advice and Guidance

Available via e-RS

 

Investigations

Diagnosis is usually clinical. No investigations required.

 

Referral

1.Fast track cancer pathway

  • Any concerns regarding skin malignancy

 

2.Dermatology routine referral: (For consideration of Photodynamic Therapy (PDT))

  • Young patients (<35 years)
  • Evidence of extensive UV damage
  • Immunosuppressed
  • Periocular AK
  • Xeroderma pigmentosum
  • Failure to respond to primary care management 

 

Useful Information:

Professional:

 

Patient:

 

References:

  • AK-Pathway-2025-Update-web.pdf
  • Berker, D., McGregor, J., Mohd Mustapa, M.F., Exton, L.S., & Hughes, B.R. (2017). British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis 2017. British Journal of Dermatology, 176

 

Page Review Information

Review Date:          21 April 2026

Next Review date:   21 April 2028

Sifter Name:            Dr Kate Northridge

Contributor:             Dr Alexander Anderson, Consultant Dermatologist Royal Cornwall Hospital Trust