No one thinks a dry, rough spot on their forearm or scalp could lead to something nasty—until it does. You hear stories about your mate’s granddad going in for a routine check, only for the doc to find something pre-cancerous lurking in plain sight. Here in Perth, where the sun can burn a hole in you quicker than you can say “slip, slop, slap,” watching for actinic keratosis is more than just wise—it’s essential. This isn’t about panicking; it’s about getting ahead. Self-exams only take a few minutes, and they could stop skin cancer before it ever gets the chance.

What is Actinic Keratosis: Hidden Risks on Sun-Damaged Skin

Let’s cut through the jargon right away. Actinic keratosis (AK for short) is a scaly, crusty spot that pops up on skin you’ve baked in the sun too long—think arms, ears, nose, scalp, and even that thin skin on the back of your hands that gets the full assault when you’re out fishing or driving. These spots can feel like sandpaper, but don’t always look like much: pale, pink, red, or sometimes the same colour as your skin. If you’re fair-skinned or over 40, the odds just keep rising. Here’s the kicker: Left ignored, some of these harmless-looking patches can turn into squamous cell carcinoma, the second most common kind of skin cancer.

Australia practically leads the world in actinic keratosis cases. According to a 2023 survey from the Skin & Cancer Foundation, about 40% of Aussies over 40 will get at least one AK in their lifetime. That’s almost every second bloke or sheila over the age of forty. UV levels play a massive part, and the World Health Organization labels Perth as one of the cities with the highest average UV indexes worldwide—hitting "Extreme" almost half the year.

AKs happen because UV light damages the DNA in your skin cells, especially the keratinocytes. This damage adds up from childhood on. Sunburns, year after year, turn into a tally of risk. It's not just about weekend warriors—tradies, surfers, gardeners, anyone who spends hours outside is getting more than vitamin D. The onset isn’t sudden. Actinic keratosis creeps up, starting as a feeling—like a patch of skin that’s always just a bit rough, maybe tender when you absent-mindedly scratch it. Maybe it flakes when you brush it, or bleeds a little after you shave. The trouble is, AKs don’t shout for attention. Sometimes they vanish for weeks, then flare up if you forget the sunscreen.

To get specific, early actinic keratoses are usually flat or slightly raised. They’re often no bigger than a pencil eraser, rougher than the skin around them, sometimes easier felt than seen. The edges are usually well defined, but not always. The colour is dull—paler or redder than your normal skin. Over time, the patch can grow, thicken, turn wart-like, or even develop a yellowish crust. About 10% of untreated AKs will eventually become squamous cell carcinoma, which is the scary turning point. Catching them early is the smart move.

Fact	Data/Detail
Average age for AK appearance	Mid-40s (younger with high UV exposure)
Percentage of Aussies over 40 with AK	40%
Risk of AK becoming skin cancer	About 1 in 10 (if left untreated)
Common AK sites	Face, scalp, ears, backs of hands, forearms
Feels like	Sandpaper; occasionally tender or itchy

One myth that leads people astray: AKs hurt. Most don’t, at least not at first. Don’t wait for pain—if you spot something rough or persistent, it’s worth a second look. If a new spot keeps returning, bleeds, or grows, that’s a red flag you shouldn’t ignore.

How to Do a Skin Self-Examination: Steps, Tools, and Patterns to Spot

Ready for the good news? You don’t need a fancy gadget, just decent light, a full-length mirror, and a hand mirror for the tricky angles. You want to scan your entire body, not just your face or arms. That means scalp (yes, move your hair), ears, neck, shoulders, chest, back, buttocks, tops and bottoms of feet—even under fingernails and toenails. Curious how easy it is to miss something? A 2020 Australian study showed that almost 35% of AKs are first spotted by partners or family, not by the person who has them. That’s why checking all the nooks and crannies matters.

If you want to do it right, here’s your checklist:

• Pick a time—after a shower is easiest, when you’re already undressed and skin is clean.
• Use natural daylight if possible; overhead lights can cast shadows that hide texture.
• Stand in front of the big mirror and work your way down—forehead, cheeks, nose, ears. Look for new or changing spots, especially ones that feel gritty or rough.
• Tilt your head, check your scalp by parting your hair in different spots. This part needs patience, especially for blokes like me with thick (or thinning!) hair.
• Use the hand mirror for your neck and behind your ears.
• Move to your arms—backs, fronts, elbows, and all around hands and wrists.
• For your back, turn your back to the big mirror and use the hand mirror to check behind shoulders and spine.
• Don’t forget your legs, especially the shins and tops of feet.
• Check under nails and around toenails for rough, scaling patches.

The AK pattern is pretty straightforward: Find any rough, scaly, or crusty patch that doesn’t heal in a few weeks, or is getting worse, and make a mental note or snap a photo for tracking. If it’s new or changed, circle the spot with a washable marker and give it a few days—if it lingers, get it checked by your doctor or skin clinic. Don’t put it off, mate. A typical AK can be so subtle, you might only notice it when shaving (a tiny nick that never fully heals) or running your hand over your forehead and feeling a bit of sandpaper where it should be smooth.

Here’s a trick from Perth’s top dermatologists: Use the “ugly duckling” rule. Most of us have a pattern of moles and freckles. The outlier—the one that doesn’t match the others—is the one you want to focus on. An AK isn’t usually brown like a mole, but its roughness stands out from the rest of your skin. Be especially suspicious of patches that are persistent, especially on sun-exposed skin.

It’s a great idea to log your finds. Take clear photos with your phone (include a coin for scale), and note down any spots that seem to come and go, or stick around. Repeat your exam every 3-6 months, more often if you work outdoors. If you have a partner, ask them to check your scalp and back. Two sets of eyes are always better than one.

Here's a quick table to keep your checks straight:

Step	What to Look For	Tools Needed
Face and ears	Rough, flat or raised spots, persistent redness, scaling	Big mirror
Scalp	Scaly patches, hard to heal sores	Hand mirror, comb
Arms and hands	Sandpapery patches on sun-exposed areas	Natural light
Back and neck	Isolated rough spots, skin that’s a different texture	Hand mirror
Legs and feet	Dry, rough, or crusty areas that stand out	Bright light, stool if needed

Don’t forget: AK can develop in places you don’t expect. The lower lip (especially if you work outdoors or surf), around the ears, and on balding scalps are hot spots. It’s not all about sunbathers—just living in a sunny place puts your skin on the line.

Prevention, Early Action, and What to Do if You Spot a Suspicious Patch

The harsh truth is that sun damage adds up, even from casual days out, and even if you’re using sunscreen most of the time. Some people assume they’re safe in winter or on cloudy days, but UV rays worm their way through clouds and still get you. The solution sounds simple, but it’s easy to forget: Wear broad-brimmed hats, UV-blocking sunnies, long sleeves, and slather on SPF 50+ before you go out. Here in Perth, every weather app now includes the UV index—when it’s 3 or higher, you need protection.

But what if you’ve already got a suspicious patch? Here’s where being proactive makes all the difference. Actinic keratoses are treatable in a bunch of ways: cryotherapy (liquid nitrogen), topical creams that prompt your body’s immune system to clear damaged cells, laser and light-based therapies, even surgical removal for thicker lesions. The shorter the delay between spotting something and getting it treated, the smaller the chance it’ll morph into a problem. If you’re worried about scarring or downtime, tell your doc—they can tailor treatment to the size and site of the patch and your skin type.

Another good tip: Get regular checks from your GP or a skin clinic, especially if you’ve ever had AK, a previous skin cancer, or you’re over 40. In Western Australia, targeted outreach programs offer free skin checks for at-risk groups—you can book a spot online, and many don’t require a referral. Don’t self-diagnose everything, either. Not every rough patch is dangerous, but assuming all’s fine because it’s “prolly just dry skin” isn’t a strategy any doc would cheer. Always get professional eyes on patches that aren’t healing.

If you have kids or teens, now’s the time to hammer home sun-safe habits. About 80% of lifetime sun damage happens before the age of 18, according to the Cancer Council. A few bad sunburns as a teenager double the risk of actinic keratoses later in life. Modeling good behaviour—hats, shirts, and seeking shade—pays off over decades.

Let’s get real for a second: Most people ignore or procrastinate on skin checks because it feels awkward or low priority. But you’ve got every reason to do it—these are five-minute jobs every season that could save your life, or at the very least, keep your skin from needing stitches and salves later on. Even if you’re the tan-at-all-costs type in your twenties, a decade down the track you’ll be grateful for every check you bothered to do.

If you find an actinic keratosis or even just suspect one, set up a doctor’s appointment. Don’t pick or scratch at it, and don’t try to scrape it off yourself. Avoid direct sun exposure over that spot until it’s been checked. If you’re worried about a wait time, mention it’s a persistent or non-healing spot—clinics usually bump these up in triage. If the doc confirms an AK, they’ll lay out your options and give you a follow-up plan to make sure nothing new develops.

In the meantime, keep an AK notebook—tracking spots you find and their changes can help both you and your skin specialist spot patterns or recurrences. Sunscreen (SPF 50+, broad spectrum) should be non-negotiable. Reapply every two hours, and go heavy on the amount—a dollop the size of a twenty-cent coin per limb is about right.

One final fact: People who do regular self-exams reduce their risk of advanced skin cancers by as much as 42%. That’s the kind of number you want in your favour. Think of it like checking your car tyres—not flashy, but when something’s wrong, it’s the first thing you’ll be glad you looked at earlier.