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Solar (actinic) keratosis Solar keratoses are premalignant lesions (the epidermal basal cell layer is dysplastic) that indicate chronic sun damage and are a marker of the risk of developing skin cancer. About 20% regress spontaneously. Progression of single lesions to SCC is uncommon (<1/1000 per annum). Areas of coalescing solar keratoses on sun-damaged skin, i.e. ‘actinic field change’, have a higher risk of progression to SCC, particularly in the context of immunosuppression. What should I look for? • Asymptomatic or slightly itchy, brownish red, discrete scaly/keratotic patches on sun- exposed skin: bald scalp, face, helix of the ear, dorsum of the hands, and forearms. • Some may be raised and warty: hypertrophic solar keratosis. • Pain, induration, inflammation, or ulceration (suggests progression to SCC). Signs of chronic sun damage, including skin tumours: BCC, SCC, malignant melanoma. What should I do? • Advise patients to monitor their skin for development of […]

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