Actinic Keratosis & IEC / Bowen’s Disease
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Overview
Actinic Keratosis
(Solar Keratosis)
Both solar keratosis and intraepidermal carcinoma (IEC) are forms of sun-related skin damage caused by long-term exposure to ultraviolet (UV) radiation.
They are early warning signs of potential skin cancer, and with early diagnosis and treatment, outcomes are excellent.
What Is a Solar Keratosis?
A solar keratosis, or actinic keratosis, is a precancerous skin lesion caused by long-term UV exposure.
It represents damage to the outer layer of the skin (epidermis) and is common in fair-skinned people who have spent considerable time outdoors.
What Does It Look Like?
- Rough, scaly, or crusty patches on sun-exposed areas (face, scalp, ears, hands, forearms, or lower legs)
- Feels sandpaper-like
- Colour varies — pink, red, or brown
- May be tender or itchy, though often painless
Why Is It Important?
Solar Keratosis are not skin cancers but 10-20% of them will turn into cancer and the vast majority of squamous cell carcinomas begin their life as Solar Keratosis. That is why early detection and treatment is recommended.
Who Gets Solar Keratoses?
- People with fair skin, light eyes, and light hair
- Those who work or spend much time outdoors
- Individuals with a history of sunburns or tanning
- Older adults (more common after age 40)
Treatment Options
Treatment depends on the number, location, and thickness of the lesions:
- Cryotherapy – freezing with liquid nitrogen
- Topical creams – 5-fluorouracil, imiquimod, diclofenac
- Photodynamic therapy (PDT)
- Curettage or laser treatment for thicker spots
- Sun protection to prevent new lesions
Prevention and Skin Care
- Apply broad-spectrum SPF 50+ sunscreen daily
- Wear hats, sunglasses, and protective clothing
- Avoid sun exposure during peak hours (10 am – 3 pm)
- Schedule regular skin checks with your doctor
When to See Your Doctor
Seek medical review if a lesion:
- Becomes tender, bleeds, or ulcerates
- Grows rapidly
- Develops a lump or crust that won’t heal
Intraepidermal Carcinoma (IEC) / Bowen’s Disease
What Is IEC?
IEC (Intraepidermal Carcinoma), also known as Bowen’s disease, is an early form of skin cancer. Abnormal cells develop in the top layer of the skin (epidermis) but have not yet invaded deeper layers. Because it remains on the surface, it is not dangerous if treated early, but it can progress to squamous cell carcinoma (SCC) if left untreated.
What Does It Look Like?
- A red, scaly or crusted patch on the skin
- May be flat or slightly raised
- Slow-growing and may not heal
- Common on sun-exposed areas (legs, face, hands, neck)
- May itch or become sore, though often painless
Causes
- Chronic sun exposure (UV damage)
- More common in fair-skinned individuals
- May arise in previously injured or inflamed areas
- Higher risk in those with a weakened immune system
Diagnosis
Doctors often recognise IEC by its appearance, but a skin biopsy (a small sample sent to a laboratory) may be taken to confirm the diagnosis.
Treatment Options
Treatment depends on the lesion’s size, thickness, and location:
- Cryotherapy – freezing with liquid nitrogen
- Topical creams – e.g. 5-fluorouracil (Efudix)
- Curettage and cautery – scraping and sealing the area
- Photodynamic therapy (PDT) – light-based treatment
- Surgical excision – removal under local anaesthetic for larger or resistant lesions
Outlook
- Most cases are successfully treated
- Recurrence can occur — regular skin checks are important
- If left untreated, some may progress to invasive SCC
Prevention
Seek medical review if a lesion:
- Protect your skin from UV exposure:
- Use SPF 50+ sunscreen daily
- ear hats, protective clothing, and sunglasses
- Avoid midday sun when UV levels are highest
- Check your skin regularly for new or changing spots
- Attend routine skin checks with your doctor
