If you've spent a significant amount of time in South Florida — whether you were born here, moved here decades ago, or show up every winter to escape the cold — your skin has been logging sun exposure for years. And at some point, that log starts to show up in ways that are easy to brush off.
A rough patch on your forehead. A scaly spot on your ear that won't go away no matter how much you moisturize. A dry, slightly raised area on the back of your hand that feels a little different from the skin around it. These things are easy to ignore, especially when they don't hurt and don't look alarming. But they deserve a closer look, because they may be actinic keratoses — and actinic keratoses are precancerous skin lesions.
That word — precancerous — matters. It doesn't mean you have skin cancer right now. But it does mean your skin is giving you a warning, and it's worth listening to.
Actinic keratosis (AK) is one of the most common skin conditions in the United States, and it's even more prevalent here in South Florida where UV exposure is relentless twelve months a year. At its core, an AK is a rough, scaly patch that develops on skin that has been damaged by years of sun exposure. The top layer of skin cells — called keratinocytes — begin to grow abnormally in response to that cumulative UV damage.
Most people describe them as:
They most often appear on areas that receive the most sun: the face, scalp (especially in people with thinning hair), ears, neck, forearms, backs of the hands, and lips. If you've read about why the ears and neck are among South Florida's most sunburned skin zones, you already know these spots take a beating that most people underestimate.
The size can vary — from as small as a few millimeters to over an inch in diameter. Some people have just one. Others develop several scattered across sun-exposed skin over the years.
When we say actinic keratoses are precancerous spots on skin, we mean it in a very specific and important way: left untreated, a percentage of AKs will progress into squamous cell carcinoma — a type of skin cancer that can spread if it's not caught and treated early.
Estimates vary, but research suggests that roughly 5 to 10 percent of untreated actinic keratoses will develop into squamous cell carcinoma over time. When you have just one, that might sound like a small number. But most patients don't have just one. And cumulative risk — across multiple lesions, across many years — adds up in a way that deserves attention rather than a wait-and-see approach.
Here's the harder part: you can't look at an AK and know with certainty whether it will progress or resolve on its own. Some do resolve without treatment. Others don't. A dermatologist can evaluate them and help you make an informed decision about what to watch versus what to treat — but that decision should be made with real clinical eyes, not a hopeful guess at home.
This is especially relevant in South Florida, where year-round UV exposure means the skin damage that drives AK formation doesn't stop between November and March the way it might for someone living in Minnesota. South Florida's sun makes year-round skin cancer screenings essential for exactly this reason.
The honest answer is: a lot of people. But certain factors significantly increase your risk.
Cumulative sun exposure is the biggest driver. If you've lived in South Florida for decades, worked outdoors, spent time on boats, played golf or tennis regularly, or simply enjoyed the beach and pool lifestyle this region is known for, your skin has absorbed a significant UV load over the years. That exposure compounds — meaning the damage from your 20s is still showing up in your 50s and 60s.
Fair skin increases susceptibility, because lighter skin has less melanin to absorb and deflect UV rays. People with light eyes, light hair, and a tendency to burn rather than tan are at notably higher risk. But it's important to note: AKs can develop in people with darker skin too, and those cases are sometimes identified later because the lesions may be less visually obvious. Darker skin tones already miss more melanoma diagnoses in South Florida — the same pattern of underrecognition can apply to precancerous changes.
Age plays a role because AKs are the result of cumulative damage. They're rare in people under 40 and become increasingly common from the 50s onward. South Florida's large and growing snowbird and retiree population means there are a lot of people in this region whose skin has had decades of unprotected sun exposure — often before the era when SPF was a household concern.
A history of sunburns — especially repeated, severe sunburns — accelerates the cellular changes that lead to AK formation. The same is true for people who used tanning beds in younger years or who have worked around UV-reflective surfaces like water, sand, and pavement for extended periods.
Immunosuppression — whether from a medical condition, organ transplant medications, or certain treatments — raises risk significantly. The immune system plays a role in detecting and correcting abnormal skin cell growth, and when it's compromised, AKs and skin cancers can develop faster and in greater numbers.
One of the reasons actinic keratoses are South Florida's most overlooked precancerous skin warning is simple: they often don't look scary. They don't bleed. They're not dramatic. A lot of people chalk them up to dry skin, age spots, or just another quirk of getting older in a sunny climate.
Here's what makes them easy to misidentify:
They can look like dry skin. A rough, flaky patch on the forehead or cheek can easily be mistaken for dehydration or windburn — especially in people who spend a lot of time on boats or in the ocean. Moisturizer doesn't fix them, but it can temporarily make them less noticeable.
They can look like age spots. Some AKs have a slightly brownish or pigmented quality that makes them resemble harmless seborrheic keratoses or sun-induced hyperpigmentation. These all look similar to the untrained eye. Understanding the difference between brown spots and more concerning skin changes is something a dermatologist can help you sort out clearly.
They don't always feel like anything. Most AKs are asymptomatic most of the time. Some people notice occasional itching, tingling, or a burning sensation — but many feel nothing at all, which is part of why they go unaddressed for months or years.
They can come and go. An AK might scale up, flake off, and seem to disappear — only to return in the same spot. This pattern sometimes makes people feel like it's resolving on its own when it isn't.
They look different on different skin tones. On fair skin, AKs often appear as pink or red scaly patches. On medium or darker skin, they may appear as darker, rougher areas without the redness that usually prompts concern.
In most cases, a board-certified dermatologist can diagnose an actinic keratosis through a visual examination and dermoscopy — a handheld device that allows the doctor to examine the skin under magnification and polarized light, revealing patterns beneath the surface that aren't visible to the naked eye.
When there's any uncertainty, or when a lesion looks more advanced or suspicious, a biopsy may be recommended. This involves removing a small sample of skin tissue so it can be examined under a microscope. It's a simple, quick procedure, and it's the only way to definitively confirm whether an AK has begun progressing toward squamous cell carcinoma.
If you're wondering what that process actually looks like, it's less intimidating than most people expect. The area is numbed, a small sample is taken, and results are typically available within a week or two. Many patients tell us the anticipation was much worse than the procedure itself.
The good news is that actinic keratoses — when caught before they progress — are very treatable. There's no single right approach for every patient. The best treatment depends on the number of lesions, their location, your overall health, and other factors your dermatologist will evaluate.
Here are the most common options:
Cryotherapy (liquid nitrogen) is one of the most frequently used treatments for individual lesions. The dermatologist applies liquid nitrogen directly to the AK, freezing the abnormal cells. The treated area blisters, then heals over one to two weeks as the damaged tissue is replaced by normal skin. It's quick, effective, and well-tolerated.
Topical prescription creams are often used when a patient has multiple AKs spread across a larger area — what dermatologists call "field cancerization." Medications like fluorouracil (5-FU), imiquimod, or diclofenac gel work by targeting abnormal cells in the treated area, causing them to break down over a course of several weeks. These can be used at home under a dermatologist's direction. The skin may look red and irritated during treatment, but this is typically temporary.
Photodynamic therapy (PDT) involves applying a photosensitizing solution to the skin and then exposing it to a specific wavelength of light that activates the agent and destroys abnormal cells. PDT is particularly effective for extensive field cancerization and can address both visible AKs and subclinical (not yet visible) damage in the same area.
Curettage — scraping away the lesion — is sometimes used for thicker or more hyperkeratotic AKs that don't respond as well to freezing or topicals.
Chemical peels and laser treatments may also be appropriate in certain situations, particularly when sun-damaged skin spans a larger surface area.
For patients with a high burden of AKs or a history of skin cancer, ongoing monitoring and periodic treatment are often part of a long-term management plan rather than a one-and-done visit.
This is the part of the conversation that's worth being direct about.
When an AK progresses to squamous cell carcinoma, it crosses the line from a precancerous lesion to an actual skin cancer. Early-stage squamous cell carcinoma is still very treatable — often with excision or Mohs surgery, which removes the cancer while preserving as much healthy surrounding tissue as possible. But the window matters. A squamous cell carcinoma that's caught while it's still superficial is a very different situation from one that has had time to grow deeper or spread.
Signs that an AK may be progressing include: rapid growth, increasing thickness or hardness, bleeding without injury, ulceration that doesn't heal, or a change in sensation. If you notice any of these changes in a spot you've been watching, that's not a "let me Google this" moment — that's a call to your dermatologist.
The reason we emphasize early treatment isn't to alarm anyone. It's because the dermatologists at Dermatology Experts see, regularly, how different outcomes look when something is caught early versus when it isn't. The earlier the better isn't just a cliché in dermatology. It's the reality.
Treating existing AKs is only part of the picture. Because actinic keratoses are caused by cumulative UV damage, the skin that developed them is at risk for developing new ones — and for other forms of skin cancer — unless ongoing sun protection becomes a priority.
That means:
It's also worth being thoughtful about which sunscreen ingredients work best for your skin, because some patients with sensitive or reactive skin find that certain formulations cause irritation that ends up discouraging consistent use. A dermatologist can help you find options that protect without causing problems.
Actinic keratoses are common everywhere, but they're more common — and develop earlier — in places where UV exposure is high year-round. South Florida is one of those places.
We don't have a real offseason for sun damage here. The UV index in Miami in January can still be high enough to damage unprotected skin. People who've lived here for thirty years have often accumulated decades of sun exposure without the seasonal breaks that residents of colder climates receive involuntarily. Add in the boating culture, the beach culture, the outdoor dining, the sports, and the lifestyle that keeps people outside twelve months a year, and the cumulative load is significant.
South Florida's boating and fishing culture alone puts skin at serious risk for melanoma — and the same consistent outdoor exposure that drives melanoma risk also drives AK formation. These risks don't exist in isolation.
If you're someone who's spent a lot of time in the South Florida sun — or if you're a snowbird who's been visiting for years and hasn't had your skin evaluated recently — this is worth taking seriously. Not with alarm, but with the calm, clear-eyed awareness that your skin has been working hard and deserves some attention.
If any of the following describe you, it's a good time to schedule a visit with a dermatologist:
You don't need to wait until something looks scary. In fact, the whole point of catching precancerous skin lesions is that you address them before they become something scarier. That's exactly the kind of proactive care that makes a real difference in outcomes.
At Dermatology Experts, Dr. Angelo Ayar and the team see patients across Miami, Parkland, and Tamarac — serving Miami-Dade, Broward, and Palm Beach counties. Whether you have a specific spot you're concerned about or you're overdue for a full-body skin check, the team is here to give you straightforward answers and a clear path forward. No runaround, no unnecessary alarm — just honest, experienced care from people who genuinely want to help you stay healthy.
Your skin has been keeping up with South Florida's sun for years. Give it a little backup.