Category: Cleveland

Actinic keratosis (AK) is a rough, scaly patch of skin caused by years of sun exposure, and yes, it can turn into skin cancer. Specifically, untreated actinic keratoses can progress into squamous cell carcinoma (SCC), the second most common type of skin cancer. The progression rate for any individual AK is estimated at about 5% to 10% over a 10-year period, according to research published in the Journal of Clinical and Aesthetic Dermatology. That percentage may sound low for a single spot, but most people who develop one AK have several, which multiplies the cumulative risk. Actinic keratoses are considered precancerous, meaning they are not cancer yet but have the potential to become cancer if left untreated. The good news is that treatment is straightforward, effective, and can be done in your dermatologist’s office. At Chattanooga Skin and Cancer Clinic, our board-certified dermatologists diagnose and treat actinic keratoses daily across our Chattanooga, Cleveland, and Kimball locations. Catching and treating these spots early is one of the most direct ways to prevent squamous cell carcinoma from developing in the first place.

What Does Actinic Keratosis Look Like?

Actinic keratoses are easier to feel than to see, at least in their earliest stages. They often start as small, rough patches that feel like sandpaper when you run your finger over them. The texture is the giveaway. Visually, they can appear as flat or slightly raised spots that are pink, red, tan, or flesh-colored. Some develop a hard, wart-like surface, and others have a white or yellowish crusty scale on top.

They show up almost exclusively on sun-exposed skin: the face, scalp (especially in people with thinning hair), ears, neck, forearms, and backs of the hands. If you spend a lot of time outdoors or have a history of sunburns, these are the areas to watch.

One tricky thing about AKs is that they can come and go. A rough patch might appear, flatten out or seem to disappear for a few weeks, then return. This intermittent pattern leads some people to dismiss them as dry skin or minor irritation. The difference is that dry skin responds to moisturizer. Actinic keratosis does not.

Who Is Most at Risk for Developing Actinic Keratoses?

Cumulative UV exposure is the primary driver. People who have spent decades in the sun, whether through outdoor work, recreation, or living in sunny climates, have the highest risk. Fair-skinned individuals with light eyes and hair are especially vulnerable because they have less melanin to absorb UV radiation, but actinic keratoses can develop in people of any skin tone.

Age is a strong predictor. AKs become increasingly common after age 40, and by age 60 to 70, they’re one of the most frequent reasons for dermatology visits. Men develop them more often than women, likely due to historical differences in occupational sun exposure and lower rates of sunscreen use, though that gap has been narrowing.

Other risk factors include a history of frequent sunburns (especially blistering sunburns in childhood or adolescence), tanning bed use, a weakened immune system (organ transplant recipients, people on immunosuppressive medications), and previous actinic keratoses or skin cancer. If you’ve had one AK, there’s a strong chance you’ll develop more over time.

How Does Actinic Keratosis Progress to Squamous Cell Carcinoma?

The progression from AK to SCC happens on a cellular level. UV radiation damages the DNA in skin cells called keratinocytes. When enough mutations accumulate, the cells begin to grow abnormally. In the AK stage, this abnormal growth is confined to the upper layer of the skin (the epidermis). The cells look atypical under a microscope, but they haven’t invaded deeper tissue.

If the damaged cells continue to multiply and eventually break through the basement membrane (the boundary between the epidermis and the dermis), the condition is reclassified as squamous cell carcinoma. At that point, it’s no longer precancerous. It’s cancer.

There’s no reliable way to predict which specific AKs will progress and which ones won’t. That unpredictability is exactly why dermatologists recommend treating all of them rather than adopting a wait-and-see approach. Treating a precancerous spot is simpler, cheaper, and less invasive than treating a skin cancer.

What Are the Treatment Options for Actinic Keratosis?

Several effective treatments exist, and the right one depends on how many AKs you have, where they are, and how thick they are.

Cryotherapy (liquid nitrogen) is the most common treatment for individual or scattered AKs. Your dermatologist sprays liquid nitrogen directly onto the spot, which freezes and destroys the abnormal cells. It takes about 10 to 15 seconds per spot, stings briefly, and the treated area forms a blister or scab that heals within one to three weeks. No anesthesia is needed, and you can go back to normal activities immediately.

For patients with many AKs spread across a larger area (a situation dermatologists call “field cancerization”), topical medications are often a better approach. Fluorouracil (5-FU) is a cream applied at home over two to four weeks that causes AKs to become red and inflamed before they peel off and heal. The treated area looks worse before it looks better, but the end result is healthier skin with fewer precancerous cells. Imiquimod is another topical option that stimulates the immune system to target abnormal cells.

Photodynamic therapy (PDT) is a third option that combines a light-sensitizing solution with a special light source. The solution is applied to the skin, allowed to absorb for one to two hours, then activated with blue or red light. The reaction destroys AK cells while sparing normal tissue. PDT is available at our Chattanooga and Cleveland offices. It’s not offered at our Kimball location.

Does Treatment Hurt, and What Is Recovery Like?

Cryotherapy produces a brief stinging or burning sensation that lasts a few seconds during treatment. The spot may be tender for a day or two afterward. Most patients describe it as tolerable and quick.

Topical treatments like fluorouracil cause redness, peeling, crusting, and sometimes discomfort over the course of treatment. The skin can look raw and irritated, particularly during the second and third weeks. This is expected and means the medication is working. Once treatment ends, the skin heals within two to four weeks, and the result is smoother, healthier-looking skin.

Photodynamic therapy can cause moderate stinging or burning during the light activation phase, and the treated skin may remain red and sensitive for several days afterward. Sun avoidance for 48 hours after PDT is critical because the skin is temporarily hypersensitive to light.

None of these treatments require downtime in the traditional sense. You can return to work and daily activities the same day, though you may want to plan topical treatment cycles around social events since the visible redness can be noticeable.

Can Actinic Keratoses Come Back After Treatment?

Yes. Treatment removes existing AKs, but it doesn’t undo the underlying sun damage in the surrounding skin. New actinic keratoses can develop in the same areas over time, particularly if sun exposure continues. Think of treatment as addressing the current problem while ongoing sun protection prevents the next one.

Most patients with a history of AKs benefit from regular follow-up appointments (every 6 to 12 months) so new spots can be caught and treated while they’re still small and simple. Some dermatologists also recommend periodic field therapy (a round of topical treatment over a larger area) as a maintenance strategy for patients who develop frequent recurrences.

How Can You Prevent Actinic Keratoses From Developing?

Sun protection is the most effective prevention. That means daily broad-spectrum sunscreen with SPF 30 or higher on exposed skin, reapplied every two hours when outdoors. Protective clothing, wide-brimmed hats, and UV-blocking sunglasses reduce exposure to the areas where AKs most commonly develop. Seeking shade during peak UV hours (10 a.m. to 4 p.m.) makes a measurable difference as well.

It’s worth noting that the sun damage causing today’s actinic keratoses happened years or even decades ago. You can’t undo past exposure, but you can stop adding to it. People who adopt consistent sun protection habits after their first AK diagnosis develop fewer new ones going forward. Prevention isn’t a retroactive fix, but it absolutely changes the trajectory.

Frequently Asked Questions About Actinic Keratosis

Is actinic keratosis the same as skin cancer?

No. Actinic keratosis is a precancerous condition, meaning it has the potential to develop into squamous cell carcinoma but has not done so yet. Treating AKs removes that risk before cancer develops.

How many actinic keratoses is too many?

There’s no specific number that triggers alarm, but having multiple AKs across a sun-exposed area (called field cancerization) suggests widespread sun damage and a higher cumulative risk. Your dermatologist may recommend field therapy (topical treatment or PDT over a larger area) rather than treating spots individually.

Where can I get actinic keratoses treated near Chattanooga?

Chattanooga Skin and Cancer Clinic treats actinic keratoses at all three locations: Chattanooga (6061 Shallowford Road, 423-899-2700), Cleveland (3891 Adkisson Drive, 423-479-8648), and Kimball (400 Dixie Lee Center Rd, 423-815-9975). Cryotherapy is available at all locations. Photodynamic therapy is offered at Chattanooga and Cleveland.

Most moles are completely harmless, but some can be early signs of melanoma, the most serious form of skin cancer. You should see a dermatologist about a mole if it’s changing in size, shape, or color, if it looks noticeably different from your other moles, if it bleeds or itches without a clear reason, or if it appeared recently and is growing. The average adult has between 10 and 40 moles, according to the American Academy of Dermatology, and the vast majority of them will never cause a problem. But melanoma can develop in an existing mole or show up as a brand-new spot, and the difference between a harmless mole and an early melanoma isn’t always obvious to the untrained eye. That’s why knowing what to watch for, and knowing when to pick up the phone, matters. At Chattanooga Skin and Cancer Clinic, our board-certified dermatologists evaluate moles and suspicious spots every day across our Chattanooga, Cleveland, and Kimball offices. A quick evaluation can either put your mind at ease or catch something early when treatment is simplest.

What Does a Normal Mole Look Like?

A normal mole is usually a small, round or oval spot on the skin that’s one uniform color, typically brown, tan, or flesh-toned. It has smooth, well-defined borders, and it stays roughly the same size and shape over time. Most moles appear during childhood and adolescence, and it’s normal for them to darken slightly during pregnancy or with sun exposure.

Normal moles can be flat or raised. They can be tiny dots or up to about a quarter-inch across. Some have hair growing from them, which is actually a reassuring sign because melanoma rarely grows hair. The defining characteristic of a normal mole is stability. It looks the same month after month, year after year.

That stability is exactly what you’re tracking when you do monthly self-skin checks. Once you know what your moles normally look like, a change stands out.

What Makes a Mole Suspicious?

Dermatologists use the ABCDE criteria to evaluate whether a mole warrants a closer look. Asymmetry: one half of the mole doesn’t mirror the other. Border irregularity: the edges are jagged, scalloped, or blurred rather than smooth. Color variation: multiple shades of brown, black, red, white, or blue within a single mole. Diameter: the spot is larger than 6 millimeters (roughly the size of a pencil eraser), though melanomas can be smaller. Evolution: the mole is changing in any way, whether that’s size, shape, color, elevation, or texture.

Of these five, evolution is the most clinically useful. A mole that was stable for 20 years and suddenly starts growing, darkening, or developing an irregular border is worth a visit regardless of whether it checks every other box. Change is the signal.

There’s also the “ugly duckling” sign: a mole that looks distinctly different from all the others on your body. Most of a person’s moles tend to share a general family resemblance. If one spot is clearly the outlier, it deserves attention.

Can a Mole Turn Into Melanoma?

Yes, though most melanomas actually arise as new spots rather than from existing moles. A study published in the Journal of the American Academy of Dermatology found that roughly 70% of melanomas develop on previously normal-appearing skin, while about 30% arise from pre-existing moles. This means both new spots and changing old ones need monitoring.

When melanoma does develop within an existing mole, it typically causes visible changes: the mole gets larger, its color becomes uneven, its border becomes irregular, or it starts to feel different (itching, tenderness, or a sensation of firmness underneath). These changes usually happen over weeks to months rather than overnight.

The good news is that melanoma caught at its earliest stage (melanoma in situ, confined to the outer layer of skin) has a nearly 100% five-year survival rate. Catching it at a later stage, after it has grown deeper, drops that rate considerably. The thickness of the melanoma at the time of diagnosis is the single strongest predictor of outcome, which is why speed matters.

What Happens When a Dermatologist Evaluates a Mole?

The evaluation is quick and painless. Your dermatologist will look at the mole with the naked eye first, then use a dermatoscope, a handheld magnifying device with polarized light that reveals structures beneath the skin surface that aren’t visible otherwise. Dermatoscopy has been shown to improve diagnostic accuracy for melanoma by 20% to 30% compared to examination without magnification.

Based on the dermatoscopic pattern, your dermatologist will either reassure you that the mole looks benign, recommend monitoring it over time with serial photographs, or recommend a biopsy. If a biopsy is recommended, it’s done in the office that same day.

A skin biopsy involves numbing the area with a small injection and then removing part or all of the mole. The tissue is sent to a dermatopathologist (a specialist in diagnosing skin diseases under a microscope), and results typically come back within one to two weeks. If the biopsy shows melanoma or another concern, your dermatologist will walk you through next steps, which may include a wider excision or referral to an oncologist depending on the depth and type.

Do Atypical Moles Always Become Cancer?

No. Atypical moles (also called dysplastic nevi) are moles that look unusual under the microscope but aren’t melanoma. They tend to be larger than normal moles, with irregular borders and uneven coloring. Having atypical moles does increase your statistical risk of developing melanoma over your lifetime, but most atypical moles never become cancerous.

Think of it this way: atypical moles are a risk marker, not a guarantee. Someone with many atypical moles and a family history of melanoma should be monitored more closely (typically every six months rather than annually), but there’s no reason to panic about every unusual-looking spot.

Your dermatologist can help you sort out which of your moles need monitoring, which can be left alone, and which should be removed. That kind of personalized risk assessment is hard to replicate on your own, which is another reason professional exams matter.

Are There Mole Changes That Are Not Concerning?

Yes. Moles can change in ways that are completely benign. During puberty, moles may darken or grow slightly. During pregnancy, hormonal changes can cause moles to become darker or larger temporarily. As people age, moles sometimes lose color and become flesh-toned or slightly raised. A mole that was flat in your 20s and becomes slightly dome-shaped in your 50s is following a normal aging pattern.

Irritation from clothing, shaving, or friction can also cause a mole to become red, tender, or slightly swollen. If the irritation resolves within a week or two and the mole returns to its normal appearance, that’s usually nothing to worry about.

The distinction comes down to pattern versus persistence. A mole that changes briefly due to an obvious external cause and then returns to baseline is different from a mole that is progressively changing over weeks without a clear trigger. When in doubt, a professional opinion takes the guesswork out of it.

How Can You Keep Track of Your Moles Over Time?

The most practical method is a combination of monthly self-checks and photography. Pick one day each month and examine your skin head to toe in a well-lit room with a full-length mirror and a hand mirror. Photograph any moles you want to track, placing a coin or ruler next to them for scale. Store the photos in a dedicated album on your phone so you can compare month to month.

Some dermatology practices offer full-body photography and mole mapping, where every mole is professionally photographed and catalogued so that new or changed spots can be identified at subsequent visits. This is particularly useful for patients with a high mole count or a strong family history of melanoma.

At Chattanooga Skin and Cancer Clinic, we work with patients to establish a monitoring plan that matches their individual risk level. For most people, that means annual professional exams combined with monthly self-checks at home. For higher-risk patients, it may mean exams every three to six months.

Frequently Asked Questions About Moles and Melanoma

Should I be concerned about moles my children have?

It’s normal for children to develop moles throughout childhood and adolescence. Most childhood moles are benign. However, if a mole on your child is rapidly growing, has multiple colors, or looks very different from their other spots, have a pediatric dermatologist or board-certified dermatologist evaluate it. Chattanooga Skin and Cancer Clinic treats patients of all ages, including children.

Can a mole biopsy cause cancer to spread?

No. This is a common myth. Biopsying a mole does not cause cancer to spread. A biopsy is the only way to determine whether a suspicious spot is cancerous, and delaying a biopsy out of fear gives a potential cancer more time to grow.

Where can I have a mole evaluated near Chattanooga?

Chattanooga Skin and Cancer Clinic evaluates moles at all three locations: Chattanooga (6061 Shallowford Road, 423-899-2700), Cleveland (3891 Adkisson Drive, 423-479-8648), and Kimball (400 Dixie Lee Center Rd, 423-815-9975). Appointments are available Monday through Friday.