Actinic keratoses (AK), in general, are asymptomatic. Sometimes patients complain of itching or burning but when present, these symptoms should be considered signs of possible transformation to squamous cell carcinoma (SCC). AK present as small, 3- to 6-mm, red, rough, poorly circumscribed patches on sun-exposed skin (Fig. 34-1). Common sites include the nose, tips of the ears, forehead, forearms, and hands. AK are extremely common in the elderly, although given the population growth in the US sunbelt, it is not uncommon to see them in young adults. Most AK do not progress to SCC and, with scrupulous sun protection, some small and superficial lesions will resolve spontaneously. Lesions that grow rapidly, ulcerate, thicken, or become symptomatic should be held in suspicion as possible early SCCs.