Actinic Keratosis Detection and Field Treatment in Clinical Practice

AK Awareness Day is recognized globally on May 24 and serves as an opportunity to raise awareness surrounding actinic keratosis (AK), non-melanoma skin cancers, sun protection, and patient education. For the second year in a row, Almirall launched its “Hats On For AK” initiative alongside AK Awareness Day, and this year collaborated with Biofrontera and SUN Pharma. Co-founded in 2025, the social media campaign was developed as a collaborative effort involving patients, health care professionals, advocacy organizations, and the broader public to encourage conversations about AK and preventive skin care behaviors.¹

This year, the initiative again supports the work of The Skin Cancer Foundation, which partners with the campaign to promote education surrounding sun-induced skin disease and skin cancer prevention.

Deborah S. Sarnoff, MD, a board-certified dermatologist and Mohs surgeon, the director of dermatology at Cosmetique Dermatology, Laser & Plastic Surgery, LLP, clinical professor of dermatology at NYU Grossman School of Medicine, and president of the Skin Cancer Foundation, addressed the clinical importance of identifying and treating actinic keratoses during routine full-body skin checks. As president, she emphasized the role dermatologists play not only in treating existing lesions but in guiding patients toward lasting sun-protective behaviors.

In her first interview, Sarnoff discussed recognizing actinic keratosis, clinical indicators for biopsy, and strategies for counseling patients on cumulative sun damage in response. In her second interview, Sarnoff shared the importance of the "Hats On for AK" social media campaign designed to bring awareness to sun protection and reducing actinic keratosis risk.

Recognizing AKs as a Continuum Toward Squamous Cell Carcinoma

Sarnoff framed AK as a marker of cumulative sun damage rather than a benign incidental finding. She described AKs as existing on a continuum, noting the presence of a lesion signals an area of DNA mutation in the skin cell with elevated risk over time.

"Not every actinic keratosis will turn into skin cancer, but statistically it's telling us an area of sun damage is more likely to develop a squamous cell carcinoma in the vicinity," Sarnoff said.

She stressed clinicians cannot dismiss these lesions as dry skin and must use the visit as an opportunity to address the broader context of UV exposure with patients.

Detection, Treatment Approach, and the Full-Body Exam

During routine body checks, Sarnoff emphasized palpation in addition to visual inspection, with particular attention to high-risk areas including the ears, lips, scalp, tops of the hands, neck, and décolletage. For patients with multiple lesions, she recommended considering field treatment with pharmaceutical agents to address subclinical disease and reduce future AK burden. For patients with a few isolated lesions, in-office liquid nitrogen cryotherapy remains a practical first step.

"We want to try to either treat the entire field with some of the pharmaceutical agents out there to prevent future ones, or during the course of the visit, do something simple," Sarnoff said.

Heightened Risk in Immunosuppressed Patients

Sarnoff identified immunosuppressed patients as a population requiring especially vigilant surveillance. Patients with organ transplant histories on immunosuppressive drugs, as well as those with hematologic malignancies, carry compounded risk when sun damage is present.

"The combination of sun damage with immunosuppression is more likely to develop into squamous cell carcinoma, and we all know squamous cell carcinoma does have the possibility of metastasizing," Sarnoff said.

She closed by reiterating clinicians must treat AKs seriously across all patients, with particular urgency in those who are immunocompromised.

Skin Cancer Foundation Resources for Clinicians and Patients

Sarnoff highlighted several patient and clinician education tools available through the Skin Cancer Foundation. The organization's website, skincancer.org, includes condition-specific information on AK, and the Foundation publishes an annual journal—the Skin Cancer Foundation Journal—distributed to dermatologists nationwide. A printed brochure with color photographs of AK morphology is also available, covering therapeutic options and the relationship between sun-induced DNA damage and AK development.²

"We try to be advocates—to wear the hat to protect—but we also try to help our doctors," Sarnoff said.

References

1. Almirall continues partnership for second edition of the Hats On For AK initiative. News release. Almirall. May 17, 2026. Accessed June 1, 2026. https://www.almirall.com/news-media/newsroom/almirall-continues-partnership-second-edition-hats-ak-initiative
2. Publications. The Skin Cancer Foundation. Updated June 2026. Accessed June 4, 2026. https://www.skincancer.org/about-us/publications/