A diagnosis of actinic keratosis can usually be made with simple observation methods, although further testing with a skin biopsy may be needed to confirm the diagnosis. Other tests, such as blood tests or imaging tests, are not usually required.
It is important that actinic keratosis is diagnosed as early as possible as it can progress to squamous cell carcinoma without treatment. However, with timely intervention, most cases of skin cancer can be cured.
A simple examination of the characteristic patches on the skin is often sufficient to diagnose actinic keratosis. The appearance of the skin and texture of the skin on the patches is usually enough.
Typical signs that may be indicative of actinic keratosis include:
- A rough patch on the skin (may not be visible) that may be painful when rubbed
- Itching or burning of skin in affected area
- Dry lips
It is necessary to recognize that the signs of actinic keratosis are not constant and the rough patches can come and go with time. The patches may appear on the skin and remain for several months and then spontaneously flake off without atrace, replaced by smooth skin. In many cases, the patches reappear shortly afterwards, commonly after the individual spends time outdoors without adequate protection from sunlight.
In some cases, a skin biopsy may be needed to confirm the diagnosis. This is most commonly used to exclude a diagnosis of squamous cell carcinoma if the lesion is more advanced or if the patient has a history of skin cancer.
This procedure typically involves the collection of a skin sample from the affected area, which can be taken by a general practitioner with the use of a local anesthetic injection. The sample is then sent to a laboratory to be fully analyzed under a microscope.
Many cases of actinic keratosis can be entirely managed by a general practitioner without need for the involvement of a dermatologist. However, referral to a dermatologist for further assessment may be indicated in some cases, such as if:
- The diagnosis is uncertain
- The skin patches are severe or widespread
- The symptoms are unresponsive to treatment
- The patient is taking immunosuppressant medications
- There is a high risk of associated malignancy
A dermatologist may also utilize other methods in the diagnosis of actinic keratosis, such as fluorescence with a photosensitizing drug.
Once a suitable management plan for actinic keratosis has been devised, the ongoing follow-up appointments are often carried out by the patient’s general practitioner.
Reviewed by Afsaneh Khetrapal BSc (Hons)