Background: Actinic keratosis (AK) is the most common precancerous cutaneous lesion, with risk of progression to cutaneous squamous cell carcinoma. In the current study, we evaluated the efficacy of 20-MHz high-intensity focused ultrasound (HIFU), as a new treatment modality for AK. Materials and Methods: Patients with AK lesions (grades I–III) treated with HIFU were included in the study. The clinical assessment was performed 3 months after therapy. Results: Twenty-one patients (14 men, 7 women) with 108 AK lesions (grades I–III) were included in the current study. Ages ranged from 62 to 85 years (mean 72.6 years). Clinically complete resolution of the actinic damage in the treated area was detected in 72.2% of lesions. Furthermore, 28 lesions (26%) showed a reduction of the AK grade, or partial response, after the therapy. Most of the patients experienced annoying but short pain during the procedure. However, late adverse effects of the therapy, such as hypopigmentation, hyperpigmentation and erythema were reported only in a small portion of the lesions. Conclusions: 20-MHz HIFU could be an effective and safe alternative treatment for AK.

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