Actinic keratosis
A dry, rough spot that feels like sandpaper, usually 1–2 cm, skin-colored to pink, red, or brown; may itch. Appears on the face, ears, scalp.
CONDITION / FACE
Precancerous diseases of the skin and lips.
Precancerous diseases of the skin of the face and lips — changes that are not yet cancer, but sometimes turn into it: actinic keratosis, actinic cheilitis, and leukoplakia. Keratosis and cheilitis are most often treated by a dermatologist without surgery, leukoplakia in the mouth by a dentist; a surgeon is needed when the area needs to be removed.
CONCEPTUAL VISUALIZATION- What it is
- Skin or mucous membrane changes that can progress to squamous cell carcinoma.
- Most often
- Actinic keratosis is most often a skin neoplasm in light-skinned people.
- The reason
- Mostly sun; for leukoplakia — smoking and alcohol.
- Who treats it
- Skin and lips - mostly by a dermatologist, leukoplakia in the mouth - by a dentist; surgeon - when the area needs to be removed.
01 / WHAT IS ITWhat is
What is
precancerous changes.
Precancerous diseases are areas of the skin or mucous membrane where the cells have already changed, but have not yet become cancerous. Three most often occur on the face and lips: actinic keratosis on the skin, actinic cheilitis on the red border of the lip, and leukoplakia on the mucous membrane of the mouth and lips.
Actinic keratosis (also called solar keratosis) is dry, rough spots on skin damaged by the sun. This is most often a skin neoplasm in light-skinned people. Actinic cheilitis — similar changes on the lip, most often the lower lip. Leukoplakia is a white spot on the mucous membrane that cannot be wiped off.
Most of these spots do not become cancerous. But it is impossible to say in advance which spot will regenerate, so it is usually advised to treat them. Treatment is selected according to the type of change, the number of spots and their location.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow do they look?
How do they look?
precancerous changes.
Spots usually do not hurt, so they are easy to overlook. Pay attention to areas that do not disappear for a long time.
Actinic cheilitis
The lip is dry, flaky, thinned, the border of the red border is blurred, there are sores.
Leukoplakia
A white spot of an irregular shape on the mucous membrane, slightly raised, sometimes with red areas; does not hurt and does not scratch.
Alarming changes
The spot bleeds, grows, changes color, hurts, or has a nodule. An ulcer or nodule on the lip can mean the transition to cancer.
Lip cancer03 / REASONSWhy do they arise?
Why do they arise?
precancerous changes.
The main cause of changes in the skin and lips is ultraviolet, accumulated over the years. Tobacco and alcohol are more important for leukoplakia.
the sun
Actinic keratosis and cheilitis occur on skin and lips that have been exposed to ultraviolet rays for years.
Fair skin and age
Fair-skinned older people are more often affected; actinic cheilitis - mostly men over 40 years old.
Smoking and alcohol
Smoking is associated with actinic cheilitis and leukoplakia. In smokers, leukoplakia more often turns into cancer.
Depressed immunity
Immunosuppressive drugs increase the risk of actinic cheilitis; such patients require closer supervision.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Precancerous changes do not require emergency care. But the changing spot should be shown to the doctor, and after the biopsy or removal, the wound should be monitored.
103 immediately if:
- bleeding from the wound after biopsy or removal does not stop;
- the blood gushes, bright red, hard to stop.
See a doctor without delay if:
On the same day: the wound after biopsy or removal is swollen, reddened, hurts more and more, pus flows from it or the temperature rises. Scheduled, without delay: new spots appeared; the spot bleeds, grows, changes color, hurts or a nodule has appeared on it; a spot appeared on the lip; the white spot in the mouth does not go away. Urgently, without waiting for a scheduled appointment, to a dentist or maxillofacial surgeon: a seal or nodule or ulcer appeared on the lip that does not heal for more than 3 weeks; a red or red-white spot in the mouth.
05 / DIAGNOSTICSAs defined,
As defined,
what is this stain
- Review
Actinic keratosis is usually recognized on examination. The doctor also looks at the adjacent skin: often the whole area is changed, not just one spot.
- Dermatoscopy
Examination through a special magnifying glass helps to distinguish keratosis from other skin neoplasms.
- Biopsy
A piece of tissue is examined under a microscope if the stain is suspicious or does not go away after treatment. Cheilitis and leukoplakia are often checked by biopsy: cancer is sometimes found under what looks like cheilitis.
- Other reasons
A white spot in the mouth can be distinguished from thrush or biting the cheek.
06 / TREATMENTHow we treat
How we treat
precancerous changes.
The method depends on what kind of change it is, how many spots and where they are. Most methods — without surgery, at a dermatologist.
01
Actinic keratosis
Dermatologist treats.
- Follow-up
- If there is only one spot, the doctor may suggest waiting: in a year, 15% to 63% of individual spots disappear, but some reappear.
- Freezing
- Cryotherapy: the spot turns into a blister and falls off in a few weeks.
- Creams
- Imquimod or 5-fluorouracil as prescribed by a doctor; they are also applied to the entire changed area, when there are many spots.
- Photodynamic therapy
- Cream is applied to the skin and brightened. The option with daylight almost does not hurt.
- Removal
- The spot is cut out or scraped off under local anesthesia.
02
Actinic cheilitis
There is no single approach, there are few large studies.
- Surgery
- Vermilionectomy — removal of the affected red border of the lip. In a review of 10 studies, after surgical treatment, cheilitis disappeared in 92.8% of cases and returned in 8.4%.
- Laser
- The affected layer of the lips is vaporized with a laser. As with vermilionectomy, the results were good and recurrences were few.
- Without surgery
- Creams and photodynamic therapy. After non-operative methods, cheilitis disappeared in 65.9% and returned in 19.2%; relapses were more frequent after photodynamic therapy.
03
Leukoplakia
Treatment is not always necessary, but supervision is a must.
- Without tobacco and alcohol
- If you stop smoking and drink less, the stain may shrink or disappear.
- Removal
- If there is a risk of rebirth, the spot is removed with a laser or a scalpel. After operations, leukoplakia returned on average in 22%.
- Medicines
- There are currently no drugs that have been proven to prevent cancer in leukoplakia. Whether removing the stain prevents cancer has not been tested in randomized, no-treatment trials.
04
Risk and oversight
- Keratosis
- A single spot turns into cancer rarely: from 0 to 0.075% per spot per year; in people who have already had non-melanoma skin cancer, the risk is up to 0.53% per spot.
- Haylit
- Estimates of the risk of rebirth vary widely, from 3% in one observational study to 10–30% in a literature review.
- Leukoplakia
- In a meta-analysis of 41,231 patients, cancer developed in 6.64%; more often - with large non-homogeneous spots, in smokers and with cell changes.
- Sun protection
- Cream with SPF 30 and above, hat, no tanning bed; check your skin regularly.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Precancerous changes of the skin and lips are most often treated by a dermatologist - with freezing, creams or photodynamic therapy. Dr. Valikhnovskyi's Institute of Surgery takes over the surgical part in the "New Face" direction: when an area needs to be removed or a biopsy has shown cancer, the clinic removes it and closes the defect in such a way as to preserve the appearance and function of the lips and eyelids.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Removal with reconstruction in one operation — if the cut edges are clean, the defect is closed immediately; otherwise - after histology.
- Local patches — small and medium defects cover the face and neck with tissues: they are the closest in color and texture.
- Perforating facial flaps — make it possible to close the wound without rough tension and distortion of the lines of the mouth or eyes.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a close-up photo of the spot and the results of the biopsy, if any, so the doctor can pre-evaluate the situation.
- ConsultationExamination of the skin and lips; deciding whether a biopsy is needed.
- PlanWhat can be treated by a dermatologist, and what is better to remove surgically.
- TreatmentRemoval of the site and closure of the defect - often in one operation.
- SupervisionHistology control, sun protection and regular skin examinations.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Will actinic keratosis become cancer?
Mostly no: an individual spot rarely turns into cancer. But it is impossible to predict which one will regenerate, so it is usually advised to treat keratosis.
Can we just wait?
If there is only one spot, the doctor may offer observation: some of the spots disappear by themselves, but often appear again. A spot that grows, bleeds or changes is shown to the doctor.
Who treats precancerous changes?
Keratosis and cheilitis - most often a dermatologist, leukoplakia in the mouth - a dentist. A surgeon is needed when a spot needs to be excised or a biopsy has shown cancer.
Is a biopsy necessary?
Not always: keratosis is often recognized on examination. A biopsy is performed if the spot is suspicious or does not go away after treatment; with cheilitis and leukoplakia - more often.
What is vermilionectomy?
An operation during which the affected red border of the lip is removed. With actinic cheilitis, changes disappeared more often after operations than after non-operative methods.
Is it possible to get rid of leukoplakia without surgery?
Sometimes yes: if you quit smoking and drink less, the stain may shrink or disappear. There are no drugs that have proven protection against cancer, so regular monitoring is important.
How to prevent new spots?
Protect your skin and lips from the sun: cream with SPF 30 or higher, a hat, no tanning beds. For leukoplakia - smoking cessation.
Sources
17 sources · reviews, guidelines and researchshowCollapse
- European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerizationJournal of the European Academy of Dermatology and Venereology, 2024doi:10.1111/jdv.19897 ↗
- Guidelines of care for the management of actinic keratosisJournal of the American Academy of Dermatology, 2021doi:10.1016/j.jaad.2021.02.082 ↗
- S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" - update 2023, part 1: treatment of actinic keratosis, actinic cheilitis, cutaneous squamous cell carcinoma in situ (Bowen's disease), occupational disease and structures of careJournal der Deutschen Dermatologischen Gesellschaft, 2023doi:10.1111/ddg.15231 ↗
- European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications - actinic keratoses, Bowen's disease and basal cell carcinomasJournal of the European Academy of Dermatology and Venereology, 2019doi:10.1111/jdv.16017 ↗
- The natural history of actinic keratosis: a systematic reviewBritish Journal of Dermatology, 2013doi:10.1111/bjd.12420 ↗
- Actinic Cheilitis - From Risk Factors to TherapyFrontiers in Medicine, 2022doi:10.3389/fmed.2022.805425 ↗
- Malignant transformation of actinic cheilitis: A systematic review of observational studiesJournal of Investigative and Clinical Dentistry, 2018doi:10.1111/jicd.12343 ↗
- Actinic cheilitis and lip squamous cell carcinoma: Literature review and new data from BrazilJournal of Clinical and Experimental Dentistry, 2019doi:10.4317/jced.55133 ↗
- Surgical versus non-surgical treatment of actinic cheilitis: A systematic review and meta-analysisOral Diseases, 2019doi:10.1111/odi.12916 ↗
- Treatment Options and Post-Treatment Malignant Transformation Rate of Actinic Cheilitis: A Systematic ReviewCancers, 2021doi:10.3390/cancers13133354 ↗
- Oral potentially malignant disorders: A consensus report from an international seminar on nomenclature and classification, convened by the WHO Collaborating Centre for Oral CancerOral Diseases, 2021doi:10.1111/odi.13704 ↗
- Malignant transformation of oral leukoplakia: Systematic review and comprehensive meta-analysisOral Diseases, 2025doi:10.1111/odi.15140 ↗
- Interventions for treating oral leukoplakia to prevent oral cancerCochrane Database of Systematic Reviews, 2016doi:10.1002/14651858.CD001829.pub4 ↗
- Recurrence in Oral Leukoplakia: A Systematic Review and Meta-analysisJournal of Dental Research, 2024doi:10.1177/00220345241266519 ↗
- Actinic keratoses (solar keratoses)NHS, 2023nhs.uk/conditions/actinic-keratoses ↗
- LeukoplakiaNHS, 2024nhs.uk/conditions/leukoplakia ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
The figures on the page are from these sources.
A spot on the skin
does it not go away?
Send a photo of the stain. The doctor will tell you whether a biopsy is needed and who will handle it better - a dermatologist or a surgeon.