Precancerous lesions
Specialist assessment and treatment for actinic keratoses and Bowen’s disease
Actinic keratoses and Bowen’s disease are the most common precancerous changes in the skin. At Midland Skin our consultant dermatologists assess rough, scaly or persistent patches of sun-damaged skin, confirm the diagnosis and treat them where appropriate.
We see patients from Birmingham, Solihull, Coventry, Wolverhampton, Worcester and across the Midlands.
Quick Facts about precancerous lesions
Best for
Rough sun-damaged patches
Appointment
Initial dermatology assessment
Treatment
Freezing, creams or surgery
Symptoms
Rough, red, scaly patches
Provider
Consultant dermatologist
Price
See below
What are actinic keratoses and Bowen’s disease?
Both are areas of abnormal cells confined to the top layer of the skin (the epidermis). They occur on skin that has had a lot of sun over the years: the backs of the hands and forearms, the face and ears, the scalp in men with thinning hair, and the lower legs, particularly in women.
Actinic keratoses (also called solar keratoses) are usually small, multiple and scattered across an area of sun-damaged skin.
Bowen’s disease is usually a single, larger, well-defined patch. It is sometimes called squamous cell carcinoma in situ, which means the abnormal cells have the features of skin cancer but have not yet grown beyond the surface layer.
What do actinic keratoses and Bowen’s disease look like?
Actinic keratoses are often easier to feel than see at first, with a rough, sandpaper-like texture. They can be skin-coloured, pink, red or brown, and may become thickened, warty or develop a small horn. The surrounding skin usually looks sun-damaged, with blotchy pigmentation and fine wrinkles.
Bowen’s disease is typically a flat or slightly raised red patch with a scaly or crusted surface, slowly enlarging over months or years. It is often mistaken for a patch of eczema, psoriasis or a fungal infection that will not clear with the usual creams.
What causes actinic keratoses and Bowen’s disease?
The main cause is cumulative ultraviolet exposure over many years, from sun and sunbeds, whether through outdoor work, sport or holidays. They are more common with age and in people with fair skin who burn easily. People whose immune system is suppressed, for example after an organ transplant, develop them more readily and are at higher risk of progression to skin cancer.
Are they serious?
The risk that any one actinic keratosis turns into invasive squamous cell carcinoma in a given year is low, and some regress on their own. Bowen’s disease carries a somewhat higher risk of progression if left untreated.
The more important point is what they tell you about your skin. Having actinic keratoses or Bowen’s disease means your skin has had enough sun damage to develop skin cancer, anywhere on sun-exposed sites, in the future. That is why treatment is usually combined with sun protection and ongoing skin checks rather than treated as a one-off.
When should I see a dermatologist?
A dermatology assessment is worthwhile if:
- a rough, scaly or crusted patch has been present for more than a few weeks
- a “patch of eczema” has not responded to the creams you have tried
- a patch is thickening, growing, bleeding, becoming tender or forming an ulcer or horn
- you have several lesions, or they keep coming back after previous treatment
- you have had a skin cancer before, or your immune system is suppressed
- you are unsure what a lesion is and would like it checked, or you would like a full skin check
Liam Christie
Why getting the diagnosis right matters
A rough or scaly patch may be an actinic keratosis, Bowen’s disease, a harmless seborrhoeic keratosis, a superficial basal cell carcinoma, a patch of inflammatory skin disease, or an early invasive squamous cell carcinoma. These can look similar but are managed very differently: some need no treatment, some respond to a cream, and some need to be removed surgically.
Your dermatologist examines the skin with a dermatoscope and, where the diagnosis is uncertain or a lesion is thickened, tender or not responding to treatment, takes a small biopsy under local anaesthetic to confirm what it is before deciding how to treat it.
What happens at Midland Skin?
Initial dermatology assessment
A consultant dermatologist examines the lesion or area, checks the rest of your sun-exposed skin where appropriate, and asks about your sun exposure, previous skin cancers, immune suppression and treatments already tried.
Diagnosis and treatment plan
Where the diagnosis is clear, treatment options are discussed with you. Where it is not, a biopsy is taken and treatment is planned once the result is available. Cryotherapy of a small number of lesions can sometimes be carried out at the same visit where appropriate; other treatments are booked as a separate appointment.
Treatment
Carried out at the clinic, or at home in the case of prescription creams, according to the agreed plan.
Review consultation
A review is arranged to check the treated area has cleared, decide whether any further treatment is needed and plan ongoing monitoring and sun protection.
How can actinic keratoses and Bowen’s disease be treated?
The right treatment depends on the type of lesion, how many there are, where they are, how thick they are, and what matters most to you in terms of healing, downtime and appearance. Which treatment is recommended is decided at your assessment; no particular treatment can be promised before you have been seen.
Cryotherapy (freezing with liquid nitrogen) is a quick clinic treatment for a small number of individual lesions. It causes a blister or scab that heals over one to two weeks and may leave a pale mark.
Prescription creams treat a whole area of sun-damaged skin (so-called field treatment), including early lesions that are not yet visible. Options include 5-fluorouracil, imiquimod and tirbanibulin. They work by causing a controlled inflammatory reaction, so the treated skin becomes red, sore and crusted for a period of days to weeks before healing. In a large randomised trial comparing field treatments, 5-fluorouracil cream gave the most durable clearance at 12 months. Tirbanibulin is a shorter five-day course for small areas on the face or scalp, with a milder reaction. Your dermatologist will explain what to expect from the specific treatment prescribed.
Curettage and cautery scrapes the lesion away under local anaesthetic and seals the base. It is useful for thicker actinic keratoses and for Bowen’s disease, and provides a sample for the laboratory.
Surgical excision removes the lesion completely with a margin and is considered for Bowen’s disease, for lesions where invasive skin cancer cannot be excluded, and for lesions that have not responded to other treatment.
Laser resurfacing can be considered for extensive field change on the face in selected patients.
Treatment clears the lesions that are there now. It does not reverse the underlying sun damage, so new lesions can appear over the following years and some people need repeat or maintenance treatment. Ongoing sun protection and periodic skin checks are part of long-term management.
What can I do?
Protecting your skin from now on reduces the number of new lesions you develop and lowers your risk of skin cancer.
Sun protection tips
- keep out of the midday sun (11am to 3pm) between April and September
- wear a wide-brimmed hat, long sleeves and sunglasses outdoors
- apply a broad-spectrum sunscreen (SPF 30 or above, UVA rated) to exposed skin every day, and reapply when outdoors
- never use sunbeds
- check your skin every one to two months for new rough patches, or for a treated area that regrows, thickens, bleeds or becomes tender, and have any change assessed
Your dermatology appointments: FAQs
Who will assess me?
You will be seen by a consultant dermatologist experienced in diagnosing and treating precancerous skin lesions and skin cancer.
Will I be treated at my first appointment?
Not always. Where the diagnosis is clear and cryotherapy is appropriate, a small number of lesions can sometimes be treated at the same visit. Creams are prescribed once the plan has been agreed. Curettage, excision and other clinic treatments are booked as a separate appointment.
Will I need a biopsy?
Only if the diagnosis is uncertain, a lesion is thickened or tender, or it has not responded to treatment. A biopsy is a small procedure under local anaesthetic and takes a few minutes. Results are usually available within around two weeks.
What should I bring?
Details of any creams or treatments you have already used, any previous biopsy or skin cancer results, and a list of your regular medications, particularly any that suppress the immune system.
Will the cream make my skin look worse before it gets better?
Yes. Field treatments work by causing inflammation, so redness, soreness and crusting are expected and are a sign the treatment is working. You will be told what is normal, how long it lasts and when to get in touch, and many people plan the course around work or social commitments.
Why is a review consultation needed?
To confirm the treated area has cleared, to check for lesions that need a different approach, and to plan ongoing skin checks. Actinic keratoses and Bowen’s disease indicate sun-damaged skin, so a single treatment is rarely the end of the story.
Book in with us
Ready to get started? Book a consultation with our team at Midland Skin. Friendly, expert advice tailored to you.
Why choose Midland Skin?
Precancerous lesions sit on the boundary between benign sun damage and skin cancer. Our consultant dermatologists assess and treat skin cancer every week, including Mohs surgery for high-risk lesions, so a patch that turns out to be more than an actinic keratosis can be diagnosed and treated within the same clinic. We offer the full range of options from freezing and prescription creams to curettage and excision, with biopsy on site, and a structured review so that treatment can be adjusted if the response is not as expected.
Fees
Precancerous lesions Show pricing
Book ConsultationInitial dermatology assessment
Up to 25 minutes
Review consultation
Standard, up to 20 minutes
Biopsy of skin
David Powell
References used for this article
- de Berker D, McGregor JM, Mohd Mustapa MF, Exton LS, Hughes BR. British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis 2017. Br J Dermatol 2017;176(1):20–43. doi:10.1111/bjd.15107.
- Morton CA, Birnie AJ, Eedy DJ. British Association of Dermatologists’ guidelines for the management of squamous cell carcinoma in situ (Bowen’s disease) 2014. Br J Dermatol 2014;170(2):245–260. doi:10.1111/bjd.12766.
- Jansen MHE, Kessels JPHM, Nelemans PJ, et al. Randomized trial of four treatment approaches for actinic keratosis. N Engl J Med 2019;380(10):935–946. doi:10.1056/NEJMoa1811850.
- Blauvelt A, Kempers S, Lain E, et al. Phase 3 trials of tirbanibulin ointment for actinic keratosis. N Engl J Med 2021;384(6):512–520. doi:10.1056/NEJMoa2024040.
- Kandolf L, Peris K, Malvehy J, et al. European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization. J Eur Acad Dermatol Venereol 2024;38(6):1024–1047. doi:10.1111/jdv.19897.
About the Author
This page has been written and/or medically reviewed by Dr Sajjad Rajpar, Consultant Dermatologist and Medical Director of Midland Skin, Birmingham.
Dr Rajpar is on the GMC Specialist Register in Dermatology and has over 20 years’ experience in clinical dermatology. He provides clinical oversight to ensure the information on this page is accurate, balanced and consistent with current dermatology practice.
Dr Sajjad Rajpar
Date last updated: 28th Sep 2026
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