Very Scaley Spots on the Face (Pre-Cancerous)

What Causes Actinic Keratoses?

Repeated, prolonged sun exposure causes skin damage, especially in fair-skinned persons. Sun-damaged skin becomes dry and wrinkled and may form rough, scaly spots called actinic keratoses. These rough spots remain on the skin even though the crust or scale is picked off. Treatment of an actinic keratosis requires removal of the defective skin cells. New skin then forms from the deeper skin cells that have escaped sun damage.

Why Treat Actinic Keratoses?

Actinic keratoses are not skin cancers. Because they may sometimes turn cancerous, however, they should be removed.


Sun damage is permanent. Once sun damage has progressed to the point where actinic keratoses develop, new keratoses may appear, even without further sun exposure. You should avoid excessive sun exposure — but don’t go overboard and deprive yourself of the pleasure of being outdoors. Reasonable sun protection should be your aim.

Treating Actinic Keratoses

Actinic/Solar keratoses are pre-cancerous lesions and can be removed surgically with scissors or a scraping instrument called a curette. Another way of destroying actinic keratoses is to freeze them with liquid nitrogen. Freezing causes blistering and shedding of the sun-damaged skin.

Sometimes it’s unclear as to whether the growth is harmless. When this occurs, Dr. Ellerin prefers to cut the growth off and send it for microscopic analysis (biopsy). Healing after removal takes two to three weeks, depending on the size and location of the keratosis. Hands and legs heal more slowly than the face. The skin’s final appearance is usually excellent.

When there are many keratoses, a useful new and updated treatment is the application of 5-fluorouracil (5-FU). The medication is rubbed on the keratoses for 7 days followed by an in-office application of a medication by the nurse, which speeds up the healing process. 5-FU destroys sun-damaged skin cells without affecting normal skin.