These common pre-malignant lesions are usually seen as rough reddish brown macules on the sun exposed areas of the face, head, neck, scalp, upper chest/back, and extensor forearms (figure 17).  The current wisdom is that a small but finite number of these lesions progress to squamous cell carcinoma of the skin.  Multiple actinic keratoses represent the fertile fields upon which skin cancers may ultimately grow.

Actinic keratoses can be easily treated with liquid nitrogen.  However, most military primary care providers do not have this available when deployed.  If this skin lesion recurs despite treatment, a biopsy or referral to a dermatologist is recommended.

Written and revised by CAPT Dennis A. Vidmar, MC, USN, Department of Military and Emergency Medicine, and Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD (1999).

Additional images provided by CAPT Vidmar in June, 2000, subsequent to the initial publication of this manual.