Solar Keratosis (Actinic Keratosis): What Every GP Needs to Know

What Is Solar Keratosis?

Solar keratosis, also called actinic keratosis, is a precancerous skin lesion caused by chronic sun exposure.

It’s extremely common in Australia - especially among older patients, outdoor workers, and those with fair skin (Fitzpatrick types I–III).

While not every solar keratosis becomes cancerous, they are markers of UV damage and a warning sign for future squamous cell carcinoma (SCC).

What Do Solar Keratoses Look Like?

You might hear patients say:

“It’s just a dry patch - I thought it was sunburn that didn’t heal.”

 Red Flags: When to Suspect Malignant Change

Solar keratosis can progress to invasive squamous cell carcinoma. Signs of transformation include:

• Rapid growth
• Ulceration or bleeding
• Induration (firm, raised base)
• Pain

 If any of these features are present, biopsy or urgent referral is warranted.

How GPs Diagnose and Manage Solar Keratosis

1. Clinical Diagnosis

• Usually diagnosed by inspection and palpation
• No need for biopsy unless suspicious for SCC

2. Management Options

3. Prevention and Monitoring

• Sun protection education: SPF 50+, wide-brim hats, long sleeves
• Full skin checks annually (or more frequently if high risk)
• Address patient beliefs: “It’s just a bit of sun” vs reality of UV damage

 Why It’s Tested in RACGP and ACRRM Exams

A/Prof George Eskander, PassGP Chief Examiner, explains:

“Solar keratosis is a bread-and-butter dermatology question - it tests your ability to differentiate benign from malignant, manage in primary care, and explain treatment to patients clearly.”

Our PassGP KFP and AKT cases often include:

• Solar keratosis vs SCC vs BCC vs seborrhoeic keratosis
• Cryotherapy dosing decisions
• Efudix counselling (e.g. inflammatory response = success)
• Safety netting and follow-up timeframes

Sample KFP-Style Prompt (PassGP Format)

David, aged 72, presents for a routine skin check. He has multiple rough, pink, scaly patches on his scalp and forehead. He is a retired farmer and spends a lot of time in the garden.

 Expected registrar actions:

• Diagnose solar keratosis
• Treat with cryotherapy OR initiate Efudix
• Provide sun safety advice and arrange skin surveillance

What Makes PassGP Different?

At PassGP, we don't just teach dermatology - we teach exam technique and communication strategy.

Our 4,500+ questions include:

• High-yield dermatology KFPs
• Mock CCE skin lesion cases
• Clear photos and drug regimens
• Detailed Efudix vs Imiquimod counselling strategies

Ready to upskill? Try the PassGP free trial or book a 1:1 consultation with our educators.