If you’ve noticed rough, scaly patches on your skin that just won’t go away, they may not be simple dry spots. These areas are often actinic keratoses (AKs) — commonly called “sun spots” or “precancerous spots.” They develop after years of accumulated UV exposure and are especially prevalent in high-sun regions like Nevada and Arizona.

At Thomas Dermatology, actinic keratoses are among the most common conditions we diagnose and treat. The good news: AKs are highly manageable, and modern dermatology offers several effective in-office and topical treatments to remove them and reduce your risk of skin cancer.

What Is Actinic Keratosis?

Actinic keratosis is a precancerous skin condition caused by long-term UV damage. Over years of sun exposure, UV radiation damages skin cells and can eventually cause rough, scaly patches to form on the skin’s surface.

Dermatologists treat AKs because a portion of untreated lesions can progress to squamous cell carcinoma, a type of skin cancer. While the per-lesion risk is relatively low, patients with many lesions face a meaningfully higher cumulative risk — which is why early evaluation matters.

AKs are most common in people who:

• Live in high-sun climates like Nevada or Arizona
• Spend significant time outdoors
• Have fair or sun-sensitive skin
• Have a history of sunburns
• Are over age 40, though younger people can develop them too

Because sun damage accumulates gradually over decades, many patients begin noticing AKs later in life.

What Do Actinic Keratoses Look Like?

AKs can vary in appearance, but most share similar characteristics. Common signs include:

• Rough or scaly patches that feel like sandpaper
• Flat or slightly raised spots
• Red, pink, tan, or skin-colored lesions
• Crusty or flaky areas of skin
• Spots that itch, sting, or occasionally bleed

Many patients notice the texture before they notice the appearance — the spot feels rough before it looks distinct.

AKs most often appear on areas that receive the most sun exposure:

• Face and ears
• Scalp
• Neck
• Forearms and hands
• Shoulders

Because they stem from cumulative damage, multiple lesions often appear in the same general area.

Why Dermatologists Treat Actinic Keratoses

AKs are considered precancerous lesions. While not every AK will progress to cancer, dermatologists cannot reliably predict which ones will. Treating them early helps:

• Prevent potential progression to squamous cell carcinoma
• Remove damaged skin cells before they advance
• Improve the health and appearance of the skin
• Reduce the number of future lesions in sun-damaged areas

Early treatment is typically quick, effective, and far less involved than treating a cancer that has already developed.

Treatment Options for Actinic Keratosis

At Thomas Dermatology, we choose treatment based on the number of lesions, their location, and the degree of sun damage in the surrounding skin. Some patients need spot treatment for one or two AKs; others benefit from field therapy that addresses an entire area of sun-damaged skin.

Cryosurgery (Liquid Nitrogen)

Cryosurgery is one of the most common treatments for isolated AK lesions. Liquid nitrogen is applied directly to the lesion, freezing and destroying the abnormal cells. The spot may blister or crust before healing over the following days. The treatment is quick — often completed in seconds — and works best when only a few lesions are present.

Topical 5-Fluorouracil (5-FU)

5-FU is one of the most widely used topical treatments for actinic keratosis. Applied to the affected area over several days or weeks, it works by targeting and destroying abnormal precancerous cells. During treatment, patients typically experience redness, peeling, and irritation — reactions that indicate the medication is actively working on damaged cells. Once treatment is complete, healthier skin forms in the treated area.

Klysiri (Tirbanibulin)

Klysiri is a newer FDA-approved topical treatment specifically indicated for actinic keratoses on the face and scalp. It works by blocking abnormal cell growth and targeting precancerous cells, and its main advantage is a short, convenient treatment course: once-daily application for approximately five days. For eligible patients with facial or scalp AKs, Klysiri has become an increasingly popular option.

Photodynamic Therapy (PDT)

Photodynamic therapy is an effective option for patients with widespread sun damage across larger areas. The process involves two steps: first, a light-sensitive solution is applied to the skin; then, the area is exposed to a specific wavelength of light that activates the solution and destroys the precancerous cells beneath.

PDT is particularly well-suited for the face and scalp, and it can improve overall skin texture in addition to treating visible lesions. Because the skin is photosensitive after treatment, patients should plan to avoid sun exposure for 24 to 48 hours following the procedure.

How Dermatologists Choose the Right Treatment

The best approach depends on several factors your dermatologist will assess during your visit:

• Number and density of lesions
• Location on the body
• Severity of surrounding sun damage
• Your lifestyle, preferences, and medical history

As a general guide: cryotherapy is often used for one or two isolated spots; 5-FU or Klysiri (face and scalp) may be recommended for multiple lesions; and PDT is well-suited for larger sun-damaged areas. In some cases, dermatologists combine treatments for the best results.

Preventing Future Actinic Keratoses

Because AKs develop from cumulative sun damage, prevention is an ongoing part of protecting your skin — especially in high-UV environments like Nevada and Arizona. Helpful habits include:

• Applying broad-spectrum sunscreen (SPF 30 or higher) every day
• Reapplying every two hours when outdoors
• Wearing wide-brimmed hats and protective clothing
• Avoiding tanning beds
• Seeking shade during peak UV hours (10 AM–2 PM)

These habits won’t undo existing sun damage, but they meaningfully slow the development of new lesions over time.

When to See a Dermatologist

Schedule a dermatology appointment if you notice:

• Rough, scaly spots that haven’t healed after several weeks
• Persistent patches of dry or irritated skin on sun-exposed areas
• New or changing lesions
• Spots that bleed, itch, or crust repeatedly

A dermatologist can quickly determine whether a spot is harmless or requires treatment — and in most cases, treatment is straightforward when caught early.

Expert AK Treatment at Thomas Dermatology

At Thomas Dermatology, our board-certified dermatology team provides advanced diagnosis and treatment for actinic keratoses and a full range of sun-related skin conditions. We offer:

• Comprehensive skin cancer screenings
• Cryosurgery for isolated lesions
• Field therapies including 5-FU and Klysiri
• Photodynamic therapy (PDT)
• Advanced dermatologic care for sun-damaged skin

With locations serving patients throughout Las Vegas, Henderson, and surrounding Nevada and Arizona communities, our team is here to help you protect your skin through early detection and modern treatment.

If you have rough or scaly sun spots that won’t go away, don’t wait. Treating actinic keratoses early is one of the most effective steps you can take to prevent skin cancer and keep your skin healthy for the long term.

Frequently Asked Questions

Is actinic keratosis the same as skin cancer?

No — actinic keratosis is precancerous, not cancer. However, untreated AKs can progress to squamous cell carcinoma over time. That’s why dermatologists recommend treating them early, before any progression occurs.

Do actinic keratoses go away on their own?

Some AKs may temporarily fade, but they rarely resolve permanently without treatment. Because dermatologists cannot predict which lesions will progress, treating them is generally the recommended approach.

How is actinic keratosis treated?

Treatment depends on the number and location of lesions. Options include cryosurgery (liquid nitrogen) for isolated spots, topical medications like 5-FU or Klysiri for multiple lesions, and photodynamic therapy for larger areas of sun damage. Your dermatologist will recommend the most appropriate approach based on your specific situation.

Is the treatment painful?

Most AK treatments involve minimal discomfort. Cryotherapy causes a brief stinging or burning sensation during application. Topical treatments like 5-FU may cause temporary redness and irritation in the treated area. PDT can cause some sensitivity, which typically resolves within a day or two.

Can actinic keratoses come back after treatment?

Treated lesions are removed, but new ones can develop in other sun-damaged areas. Ongoing sun protection and regular skin screenings are the best way to monitor for and prevent new AKs from forming.