Freckles (ephilides) are most often seen in fair-skinned individuals, particularly those with red hair. They are a result of melanin (dark skin pigment) build-up within keratinocytes (skin cells). In winter, freckles fade as the keratinocytes are replaced by new cells. Freckles usually become less noticeable with age. They can indicate that the skin is more susceptible to sun damage. Freckles do not need to be treated.
Actinic keratoses (AK) are areas of sun-damaged skin. They are scaly spots that are mostly found on the parts of the skin that are frequently exposed to sun, such as the backs of hands, forearms, face and ears. They are usually harmless but can be unsightly. There is however a small risk of some AKs turning into a type of skin cancer called squamous cell carcinoma (SCC). AK more commonly occurs in individuals that are older and fair-skinned. A tendency to burn rather than tan also predisposes a person to AKs.
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AK is usually diagnosed on appearance of the lesion alone. However, AKs can look like a SCC so there may be some doubt. In this case, a biopsy (sample) or excision can be performed, which allows more exact assessment under a microscope.
AK can be prevented by strict sun protection. Once already present there are some options.
AKs can regress by themselves and are usually not concerning. If they are flat and not causing symptoms then observation by a dermatologist may suffice. Alternatively creams such as imiquimod or 5-fluorouracil can be effective.
If on the other hand they are painful, enlarging, thickened or ulcerated then they should be treated. Treatment in this scenario usually involves removal of the defective skin cells. Options include: cryotherapy (freezing the lesion off with liquid nitrogen), photodynamic treatment (shining a red light after applying a cream that allows the skin to absorb it), curettage (scraping with a sharp instrument) and excision.