The spontaneous evolution of actinic keratosis (AK) includes regression, persistence, or progression to in situ or invasive squamous cell carcinoma (SCC). The relative risk of developing SCC increases in proportion to the number of AK lesions. 1 The most practice and easy way to classify AK is the grading system proposed in 1991 by Olsen et al 2 who identify three different lesions: AK I is better palpated than visualized, AK II is visible, and AK III is hyperkeratotic. In clinical practice, a useful diagnostic aid can be provided by dermoscopy. 3