You feel it before you see it — a small rough patch on the back of your hand, your forearm, your scalp, or the rim of your ear. It comes and goes, sometimes flaking off, sometimes feeling like fine sandpaper. After a lifetime of Southern Oregon summers spent fishing, farming, golfing, or simply driving with your arm out the window, that texture is worth a closer look. It may be an actinic keratosis — and summer, when sun-damaged skin is most active, is a natural time to pay attention.
An actinic keratosis (AK), sometimes called a solar keratosis, is a small area of skin damaged by years of cumulative ultraviolet exposure. AKs are considered precancerous: a single lesion has a low chance of becoming a squamous cell carcinoma, but they tend to arrive in groups, and over time a percentage can progress. Because there's no reliable way to predict which ones will, dermatology guidelines generally favor treating them rather than watching and waiting.
They show up where the sun lands most: the face, ears, balding scalp, lower lip, neck, forearms, and the backs of the hands. Fair skin, light eyes, and a history of sunburns all raise the odds — a profile common across our outdoor-loving region.
AKs are often easier to feel than to see. Watch for:
Any spot that grows quickly, bleeds, becomes tender, or simply won't heal deserves a prompt evaluation, since those can be signs the skin has moved beyond a precancer. When in doubt, have it checked — most evaluations are quick and reassuring.
For patients with multiple AKs across a sun-exposed area — a common pattern on the scalp, face, or forearms — photodynamic therapy (PDT) is one of the treatments we offer. PDT works in two steps. First, a light-sensitizing solution is applied to the area and allowed to absorb into the damaged cells over a period of time. Then the skin is exposed to a specific wavelength of light that activates the solution, targeting sun-damaged and precancerous cells.
One advantage of PDT is that it treats a whole region rather than one spot at a time, which can address early damage that isn't yet visible alongside the AKs you can feel. Many patients also appreciate the cosmetic improvement in overall skin texture and tone that can follow. After treatment, the area typically looks red and feels like a sunburn for several days as it heals, and strict sun avoidance during that window is essential.
PDT is one option among several. Individual lesions are often treated with cryotherapy — freezing with liquid nitrogen — during an office visit. For more widespread damage, prescription topical treatments applied at home over a course of weeks are another route. The right approach depends on how many AKs you have, where they are, your skin, and your schedule, which is exactly the conversation to have at an exam.
Southern Oregon's high number of sunny days and active, outdoor culture mean many residents have accumulated more UV exposure than they realize. AKs are the visible record of that exposure — and treating them, paired with daily sun protection and a yearly skin exam, is one of the most practical things you can do to stay ahead of skin cancer.