What exactly is it?
Actinic keratosis is a lesion caused by ultraviolet radiation accumulated over decades. It does not come from this summer’s sun: it comes from thirty summers of sun. That is why it is commoner after 40, in fair-skinned people, and in those who have worked or lived outdoors — farming, construction, sport, driving.
Technically it is an incipient squamous cell carcinoma in situ: the cells are already abnormal, but they have not yet invaded downwards. That “not yet” is the whole conversation.
It is recognised because you feel it better than you see it. Run a fingertip across your forehead, your bald scalp or the backs of your hands: if you find a rough patch that should not be there, look at it. Many are found while shaving or applying make-up, not in the mirror.
The signs that identify it
None of them is dramatic, which is why they are ignored for years:
- Sandpaper texture over a pink or reddish base. The roughness is the sign, not the colour.
- Dry, adherent scale, sometimes yellowish or brownish, that comes off and reforms.
- Recurrence: “it clears and comes back”. That cycle is the key fact. A normal scab falls off and does not return.
- Chronically exposed sites: forehead, bald scalp, ears, nose, cheeks, lower lip, backs of hands and forearms.
- Rarely painful, though it can itch, sting or bleed when rubbed.
The question that matters: does it turn into cancer?
Some do. The chance that any single actinic keratosis progresses to invasive squamous cell carcinoma is low per year, but it is not zero — and the problem is that whoever has one usually has many, for years, across a field of damaged skin. Over dozens of lesions and decades of time, the cumulative probability stops being negligible.
So the clinical logic is not “wait and see which one turns malignant”. It is treat the field. And some signs demand action immediately: a lesion that grows, thickens or hardens, hurts, bleeds, or fails to respond to treatment. That is no longer watched: it is biopsied.
How it is treated
Treatment depends on whether there are isolated lesions or an extensive field of damage. It is carried out under the clinic’s dermatology consultation:
- Cryotherapy: controlled freezing of the individual lesion. Quick, in-office, with redness and a crust afterwards. The option for a countable number of lesions.
- Field-directed therapy under prescription: when there are not three lesions but thirty, and much of the damage is still invisible, the whole area is treated instead of going spot by spot. That is the right strategy in extensive sun damage. Therapy is prescribed and supervised in consultation — no drug names or regimens are published here.
- Biopsy: mandatory for any lesion that grows, hardens, hurts, bleeds or fails to respond. Doubt is not watched: it is investigated.
- Strict, lifelong photoprotection: this is not a courtesy tip. It is the only treatment that prevents the next ones.
Where the plastic surgeon comes in
Actinic keratosis is diagnosed and treated in the clinic’s dermatology consultation. But when a lesion is biopsied and turns out to be a carcinoma, the problem stops being dermatologic and becomes surgical and reconstructive — and that is where Dr. Arístides Arellano takes over.
This matters more than it sounds when the lesion is on the face: nose, eyelid, ear, lip. Excising with an adequate margin is the easy part; closing the defect without distorting the eyelid, the nasal rim or the lip border is plastic surgery. See basal cell carcinoma and grafts and flaps.
That is the concrete advantage of both disciplines sitting under the same roof since 1971: the patient does not change institution between the diagnosis and the reconstruction.
If you have one, check the rest
Anyone with actinic keratoses has, by definition, a field of sun-damaged skin — and also an increased risk of other lesions, malignant ones included. The sensible course is not to treat the one that bothers you and forget it: it is a full skin examination, with dermoscopy, and a follow-up schedule.
What does it cost?
It depends on the number of lesions and whether treatment is spot-by-spot or field-directed. It is defined at consultation. See prices.
Track record and credentials
Actinic keratosis is assessed and treated at the Clínica Dermatológica y Cirugía Estética de Puebla, founded in 1971 by Dr. Francisco Arellano Ocampo. Clinical dermatology is the root of the house; reconstructive surgery of the cases that progress is the second generation’s contribution.
Dr. Arístides Arellano is a plastic surgeon holding a specialty licence: he practises under a Mexican medical licence (D.G.P. 1125959) and a specialty licence in Plastic & Reconstructive Surgery (0002008), both issued by the Directorate General of Professions (DGP), which reissued his certificate of professional standing in 2025. His career began before Mexico’s present-day specialty-board system existed: he belongs to the founding generation of plastic surgery in Puebla, the second generation of a surgical tradition started in 1971 by Dr. Francisco Arellano Ocampo. Trust is verified, not promised: both licences are public and anyone can look them up in the DGP’s National Registry of Professionals.
Risks and expectations
Every medical treatment —topicals, peels and energy-based devices included— carries risk and requires a prior assessment. In darker skin (Fitzpatrick IV–VI, the most common phototypes in Mexico) a poorly indicated procedure can darken the patch instead of lightening it. Results may vary according to each patient, their phototype and their individual triggers.
Trust is verified, not promised. All 210 scanned documents —degree, licences, diplomas, publications and certificates, from 1977 to 2025— are open in Dr. Arístides Arellano’s credential archive, alongside an explanation of the difference between a specialty licence and a board certification.
Treatment and follow-up
- AssessmentFull skin examination with dermoscopy. The field is counted, not just the lesion that bothers you.
- Isolated lesionsIn-office cryotherapy. Redness and crusting for 1–2 weeks.
- Extensive fieldField-directed therapy under prescription, with expected redness and inflammation during the cycle.
- Suspicious lesionBiopsy. If it is carcinoma, it moves to surgery and reconstruction.
- AlwaysStrict, lifelong photoprotection. It is the only thing that prevents the next ones.
- Follow-upPeriodic review. Whoever had one will have more.
Frequently asked questions
Is actinic keratosis cancer?
Not yet. It is a precancerous lesion: the cells are already abnormal but have not invaded downwards. A fraction progress to invasive squamous cell carcinoma. The risk of any single lesion is low per year, but whoever has one usually has many over decades, and the cumulative probability stops being negligible. That is why they are treated rather than watched indefinitely.
How do I tell it from an ordinary scab?
By two things. Texture: it feels like sandpaper, and is often felt before it is seen. And recurrence: it flakes, seems to heal, and comes back in the same spot. A normal scab falls off and does not return. If it is also on the forehead, bald scalp, ears, nose, lower lip or backs of the hands, suspicion is high.
When does it need a biopsy?
Any lesion that grows, thickens or hardens, hurts, bleeds, or fails to respond to treatment. Those changes suggest it is no longer a keratosis but an invasive carcinoma, and doubt is not watched: it is investigated with a biopsy.
Can it be removed with laser?
The standard treatment for isolated lesions is cryotherapy, and for extensive damage it is field-directed therapy under prescription, both in the dermatology consultation. What matters is not which tool is used but that any suspicious lesion is biopsied before it is destroyed: destroying a carcinoma without diagnosing it discards the information that decides the treatment.
Can I stop more from appearing?
You can greatly reduce them, and the only tool that achieves it is strict, daily, lifelong photoprotection. You already carry decades of accumulated damage; what you can control is what is added from today. Without that part, any treatment becomes an endless wheel.
What if it turns out to be skin cancer?
It is excised with a margin and, if the defect requires it, reconstructed. When the lesion is on the face — nose, eyelid, ear, lip — excision is the easy part; closing without distortion is plastic surgery, and it is performed by Dr. Arístides Arellano. Dermatologic diagnosis and surgical reconstruction have been in the same institution since 1971.
Every case is different. Discuss yours in a personal consultation.
Book a consultation on WhatsAppEvery figure published on this site is approximate and is not a quote. Any procedure or treatment first requires a private assessment consultation with Dr. Arístides Arellano —$800 MXN, charged separately— and it is at that consultation that the definitive cost of your case is determined.
Educational content; it does not replace a medical consultation. Results may vary from person to person.