Actinic keratoses first appear as an area of redness and texture change. The skin is slightly rough and may eventually accumulate scale. Pigmentation may vary from pink to brown. Actinic keratoses are most often seen on the face and ears. The back of the hands and forearms frequently form lesions. The lower legs, the chest in women and the upper back are also frequently involved. The surrounding skin can show typical features of sun damage that include brown lentigines and telangiectasias.
Lesions can be either localized and discrete or diffuse. Localized lesions form dense scale that may accumulate resulting in a cutaneous horn. Early lesions that are superficial with little scale may form over a wide area such as on the face and scalp. The lip can either accumulate scale or develop an erosion. Examine lip lesions with gloved fingers. Thick lesions may have developed into squamous cell carcinoma. The ears are another area that is difficult to evaluate. It is sometimes difficult to differentiate an actinic keratosis, squamous cell carcinoma and basal cell carcinoma when examining the ears.