Actinic Keratosis vs. Basal Cell Carcinoma: Understanding the Difference

Actinic keratosis is a type of precancerous skin lesion. It happens when you’ve had too much exposure to ultraviolet (UV) radiation, which is found in sunlight and in tanning beds.

It’s pretty common to develop actinic keratosis, especially as you get older. Its estimated prevalence in the United States is about 20%. However, it can be much higher, up to 60%, in areas of the world that receive more sunlight.

BCC is a type of skin cancer that affects basal cells, which are found in the lower parts of your epidermis. It’s estimated that BCC makes up about 80% of skin cancer diagnoses.

BCC also develops due to UV exposure. It’s typically a slow-growing cancer that remains localized to the skin. However, in rare cases, it’s possible for BCC to spread deeper into surrounding tissues or to more distant parts of your body.

Both actinic keratosis and BCC appear in areas that receive frequent sun exposure. These include your:

• face
• scalp
• ears
• lips
• neck
• shoulders
• upper back
• tops of your arms and hands

Both conditions can also vary greatly in appearance. Furthermore, they may resemble other types of skin lesions, such as age spots, pimples, moles, and eczema. This can make them harder to find without the help of a dermatologist.

Signs and symptoms of actinic keratosis

Actinic keratosis lesions are typically less than a quarter of an inch across. Many people with actinic keratosis also have more than one lesion. It can be itchy, painful, or bleed if you scratch at it.

The affected area can also vary in color. For example, actinic keratosis may present as a rough patch of skin that’s similar to your skin tone. Or, it may be different in color, such as pink, red, gray, or darker brown, depending on your skin tone.

Skin affected by actinic keratosis is often rough or scaly. In some cases, actinic keratosis can be bumpy and pimple-like. Less commonly, it can manifest as a hard, cone-shaped horn coming out of your skin.

When actinic keratosis appears on the lips, you may notice that your lips have become dry and scaly. Sometimes, they may have white patches on them or lose their color.

Signs and symptoms of basal cell carcinoma

BCC can vary greatly in appearance. For example, it may appear as a:

• patch of irritated skin that’s dry and scaly, and may also itch or hurt
• round lesion with raised edges and a depressed center
• bump that appears shiny or pearly in comparison with the surrounding skin
• flat, firm, and waxy area that has a scar-like appearance
• sore that doesn’t heal and may ooze or crust over

Sometimes, BCC lesions can have the same color as your skin. Other times, they may be red, pink, gray, or darker brown, depending on your skin tone.

Like actinic keratosis, BCC lesions may bleed if they’re scratched or become irritated.

Comparison table

The table below can help you to better compare the symptoms of actinic keratitis and BCC.

It’s important to be able to recognize the symptoms of actinic keratosis and BCC. The image gallery below provides examples of actinic keratosis and BCC lesions on different skin tones.

Both actinic keratosis and BCC are mainly caused by exposure to UV radiation. Accumulated UV exposure can damage the DNA in skin cells, leading to precancerous or cancerous changes.

In addition to UV exposure, risk factors for both actinic keratosis and BCC include:

• being an older age
• having lighter skin
• being assigned male at birth
• living in a part of the world that receives a lot of sunlight
• having a weakened immune system
• having a previous history of actinic keratosis or BCC

Additionally, 20% of BCCs don’t happen in areas with a lot of sun exposure, meaning additional risk factors are present. These are:

• having previous radiation exposure
• being exposed to arsenic
• having specific inherited conditions, including basal cell nevus syndrome or xeroderma pigmentosum

In order to diagnose either actinic keratosis or BCC, a dermatologist will first take your medical history. For example, they’ll ask you about when you first noticed a lesion and any symptoms that are associated with it.

Next, they’ll do a skin exam where they’ll examine the lesion as well as the rest of your skin. They’ll also look at the lesion under a special type of magnifying lens called a dermatoscope.

If your dermatologist is concerned that your lesion may be cancerous, they’ll take a sample of it via a skin biopsy. This sample can be examined under a microscope to see if cancer is present.

Your treatment may vary depending on if you have actinic keratosis or BCC. Additionally, factors that are important for determining the recommended treatment for both conditions can include:

• the number of lesions
• how large the lesions are
• where the lesions are located
• whether or not you have a previous history of actinic keratosis or skin cancer
• your age and overall health
• your personal preference

Let’s look at the various treatment options for each condition now.

Treatment for actinic keratosis

The potential treatment options for actinic keratosis can include:

• Topical therapies: Topical therapies are those that you apply directly to your skin. Some examples of topical therapies for actinic keratosis are:
  • 5-fluorouracil
  • imiquimod cream
  • diclofenac sodium gel
  • ingenol mebutate
  • tirbanibulin ointment
• Cryotherapy: Cryotherapy uses extreme cold to kill precancerous cells. After treatment, the lesion turns into a blister and falls off.
• Curettage and electrodessication: In this treatment, a tool called a curette is used to scrape the lesion away. Afterward, the area is treated with a tool that uses an electrical current to kill remaining precancerous cells.
• Photodynamic therapy (PDT): In PDT, a special solution that makes your skin sensitive to light is applied. The treated area is then exposed to a certain type of light that activates the solution and kills the cells in the lesion.
• Laser treatment: This type of treatment uses a laser to remove the top layers of your skin, which include the actinic keratosis lesion.

Treatment for basal cell carcinoma

One of the main treatments for BCC is surgical removal. This can be accomplished in a few ways:

• curettage and electrodesiccation
• excision, which involves cutting out the lesion along with a small area of healthy skin
• Mohs’ surgery, which involves gradually removing thin layers of skin until analysis under a microscope shows that cancer is no longer present in the last layer that was removed

Radiation therapy can also be used for BCC. This is typically recommended when a lesion can’t be treated surgically. It may also be used after surgery to kill any remaining cancer cells. This is called adjuvant therapy.

Some of the other potential treatments for BCC are similar to those of actinic keratosis. These can include cryotherapy or topical treatment with 5-fluorouracil or imiquimod cream.

In rare cases, BCC can grow deeper into nearby tissues or may spread to more distant areas of your body. In these situations, targeted therapy or immunotherapy may be used.

The outlook for people with actinic keratosis and BCC can depend on many factors, such as:

• the location, size, and number of lesions
• the type of treatment that’s recommended
• the response to the treatment
• your age and overall health

Regardless of which condition you have; you’ll need to continue to follow up regularly with your dermatologist after treatment. This can help to catch and treat any new lesions early.

Outlook for people with actinic keratosis

Because actinic keratosis can turn into SCC, it’s important to receive treatment. While the estimated risk of progression to SCC can vary greatly, the average risk is believed to be around 8%.

Many actinic keratosis lesions remain stable and never progress to SCC. It’s also possible that actinic keratosis can go away on its own. This is called regression and is estimated to happen in 25% to 50% of people.

Actinic keratosis can also recur after treatment or after regressing. This is estimated to happen within 1 year in 60% of people diagnosed with actinic keratosis.

Outlook for people with basal cell carcinoma

The outlook for people with BCC is very good when it’s diagnosed early. It’s estimated that treatment is effective for at least 90% of people with nonmelanoma skin cancers such as BCC and SCC.

BCC is slow growing, but if it’s left untreated, it can progress to an advanced stage. This is estimated to happen in 1% to 10% of people. Advanced BCCs are much more challenging to treat, and people with them have a poorer outlook.

Like actinic keratosis, it’s also possible for BCC to recur after treatment. This is estimated to occur in 5% to 15% of people who have surgery for BCC.

Actinic keratosis is a type of precancerous skin lesion that can happen due to too much UV exposure. In some cases, it may progress into SCC, a type of skin cancer.

BCC is another type of skin cancer. While actinic keratosis can’t turn into BCC, the two conditions can share similar symptoms, such as dry scaly skin, itching, and bleeding when scratched.

The outlook for both people with actinic keratosis and those with BCC is best when it’s found and treated early. Treatment depends on which condition you have, but it may involve removal of the lesion, topical therapy, or cryotherapy.

As such, be sure to see your dermatologist if you discover an area of skin that you’re concerned about. They can do tests to determine if it’s benign, precancerous, or cancerous.