Sun Damage, Sunspots and Actinic Keratosis

Sun damage refers to the cumulative effects of long-term ultraviolet (UV) exposure on the skin. Over time, UV radiation causes changes in skin cells that can lead to pigment changes, rough or scaly lesions, thinning of the skin, and an increased risk of skin cancer.

Sun damage most commonly affects areas that receive regular sun exposure, such as the face, scalp, ears, hands, forearms, and lower legs.

Sunspots, also known as solar lentigines, are flat, light-to-dark brown patches caused by chronic sun exposure. They are benign and do not turn into skin cancer.

However, their presence reflects significant cumulative sun exposure, which is associated with an increased overall risk of developing skin cancer.

Actinic keratoses are areas of sun-damaged, abnormal skin.

They may present as:

• Rough, scaly, or gritty patches

• Pink, red, or skin-coloured lesions

• Areas that feel tender or sensitive

Actinic keratoses are not skin cancer, but they are considered pre-cancerous, as a proportion can progress to squamous cell carcinoma if left untreated.

Chronic UV exposure can cause widespread damage across sun-exposed skin, a process known as field cancerisation.

This means that:

·       Abnormal sun-damaged cells may be present across a broader area of skin

·       Only some lesions are visible on the surface

·       The surrounding skin may also be at increased risk

Recognising field cancerisation helps guide treatment decisions, particularly when multiple actinic keratoses are present.

Assessment involves careful examination of sun-exposed skin to:

·       Identify actinic keratoses or early skin cancers

·       Assess the extent of background sun damage

·       Determine individual risk based on skin type, sun exposure history, and immune status

 In people with significant sun damage, ongoing surveillance may be recommended.

Management is individualised and depends on the type, number, and distribution of lesions, as well as the degree of background sun damage.

Because sun damage often affects broader areas of skin, treatment may involve:

• Targeting individual lesions, and

• Treating surrounding sun-damaged skin

Treatment options may include:

• Cryotherapy for isolated actinic keratoses

• Topical field treatments to treat larger areas of sun-damaged skin

When topical treatments are prescribed, clear guidance is provided on how to use them, expected skin reactions, treatment duration, and aftercare. Skin reactions during treatment are anticipated and form part of the treatment process.

Yes. The presence of sun damage indicates an increased risk of developing further actinic keratoses and skin cancers.

Ongoing care may include:

• Regular skin checks

• Monitoring for new or changing lesions

• Continued sun protection strategies

Long-term surveillance is an important part of care, particularly for individuals with significant sun exposure or a history of pre-cancerous or cancerous skin lesions.

Dermatologists are trained to recognise and manage the full spectrum of sun-related skin changes, from benign sunspots to pre-cancerous lesions and early skin cancers.

Specialist review supports accurate diagnosis, appropriate treatment selection, and coordinated long-term care focused on both skin health and cancer prevention.

At Ready Dermatology, North Shore Health Hub, St Leonards, our dermatologist assesses sun-damaged skin, sunspots, and actinic keratoses, and provides management and surveillance strategies tailored to individual risk.