Actinic Keratosis vs. Sunspots: What’s the Difference?

Spending time in the sun can leave its mark on your skin. While some changes, like freckles or sunspots, may be harmless, others such as actinic keratoses (AKs) can signal potential precancerous changes. At MDCS Dermatology, Marisa Garshick, MD, FAAD helps patients understand the difference between these two common sun-related skin concerns.

What Are Sunspots?

Sunspots, also known as liver spots or solar lentigines, are flat brown patches that develop after years of sun exposure.

• Appearance: Uniform in color, ranging from light to dark brown
  

• Texture: Smooth and flat
  

• Risk: Benign and noncancerous, though they indicate cumulative sun damage
  

Sunspots are primarily a cosmetic concern, but their presence can serve as a reminder to practice daily sun protection.

What Are Actinic Keratoses?

Actinic keratoses are rough, scaly patches caused by chronic UV damage. Unlike sunspots, AKs are considered precancerous and have the potential to progress into squamous cell carcinoma if left untreated.

• Appearance: Rough, crusty, or scaly patches, sometimes red or flesh-colored
  

• Texture: Feels gritty, like sandpaper
  

• Risk: Can develop into skin cancer, requiring medical evaluation and treatment
  

How to Tell the Difference

• Sunspots: Flat, smooth, and purely cosmetic
  

• Actinic Keratosis: Rough, scaly, and potentially precancerous
  

If you notice changes in color, size, or texture—or if a spot becomes painful or bleeds—it’s important to schedule a dermatology exam promptly.

Treatment Options

For sunspots, cosmetic treatments may include:

• Chemical peels
  

• Laser treatments
  

• Prescription lightening creams
  

For actinic keratoses, treatment focuses on removing precancerous cells through:

• Cryotherapy (freezing)
  

• Topical prescription creams
  

• Photodynamic therapy
  

• In-office procedures tailored to your skin
  

Expert Advice

Dr. Garshick emphasizes that while sunspots may not be dangerous, actinic keratoses require professional care. Regular skin checks and sun protection are essential in preventing progression to skin cancer.