Multiple hypertrophic actinic keratosis scattered diffusely over the dorsal hand. Some of the thicker actinic keratoses may be difficult to distinguish from squamous cell carcinoma.

Single 3–5-mm actinic keratosis with thick hypertrophic scale centrally, that may be palpable, and rough surrounding pink changes peripherally.

Actinic keratosis may accumulate a dense scale on the surface and become a cutaneous horn. These lesions require excision.

Diffuse actinic damage of the lower vermillion lip with a blunting of the junction between the red vermillion border and the cutaneous lip with advanced actinic damage and early erosive changes.