Trump's Neck Irritation Puts a Spotlight on America's Most Common Precancer

Journalists caught a glimpse of it during the Medal of Honor ceremony — a red, irritated patch on the right side of President Donald Trump's neck. Soon, dermatologists across the country were weighing in on the possible cause, and social media was flooded with speculation. Dr. Sean Barbabella, President Trump's physician and Director of the White House Medical Unit, stated it was from a "preventative skin treatment." But for the 58 million Americans already living with Actinic Keratosis (AK), the image looked very familiar.

What Is Actinic Keratosis — and Why Should You Care?

Actinic Keratosis, also known as Solar Keratosis, is the most common precancerous skin condition. If left untreated, it can progress to squamous cell carcinoma, the second most common type of skin cancer. Actinic keratosis may appear as red or scaly bumps or patches on the upper layer of the skin. Sometimes they can be hard to see, but they may feel rougher than other areas of the skin. Actinic Keratosis is caused by ultraviolet (UV) radiation from the sun or tanning beds over time. Not all actinic keratoses turn into skin cancer, but early detection remains important. Here is where AK can develop:

●      Face

●      Scalp

●      Ears

●      Neck

●      Backs of the hands

●      Forearms

Are You at Risk? The Warning Signs to Know

People who spend a lot of time in the sun or frequently use tanning beds are at risk of developing actinic keratosis. At 79 years old, with blue eyes and fair skin, President Trump fits the profile of a person who is at risk for AK. He lives in Florida, a state that has the second-highest skin cancer rate in the nation, and golfs regularly, exposing his skin to UV rays for hours at a time. Omarosa Manigault Newman claims in her memoir Unhinged that Trump fired a staff member in 2017 for improperly installing a tanning bed at the White House, raising questions about whether the President uses one himself.

Older Adults. Actinic keratoses are most common in older adults. The Canadian Skin Cancer Foundation reports that 60% of Canadians over 40 have at least one AK, and this number increases with age due to cumulative sun exposure and lack of sunscreen use. A 2022 study found that 30% of people 65 and older had one or more AKs; the majority were white men. Having multiple AKs raises the risk of skin cancers, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma.

Fair Complexion. Actinic keratosis is a common skin condition seen primarily in Caucasians. Individuals with fair complexions are prone to sunburn and UV skin damage because they have less melanin in their skin. Fair-complexioned individuals often have blue, green, or gray eyes and red or blond hair — characteristics associated with greater susceptibility to AK.

Immunocompromise. Donald Trump was hospitalized with COVID-19 in October 2020.

According to a study, even mild cases of COVID-19 can impair immune function, leaving the skin more vulnerable long after recovery. A compromised immune system is a known risk factor for Actinic Keratosis. People undergoing chemotherapy, radiation, or immunosuppressive drugs (such as corticosteroids or methotrexate), as well as those who are malnourished or have AIDS, face a higher risk of developing AK.

Location. Due to its geographical location, Florida has one of the highest incidences of skin cancer in the world, ranking second in the nation for new cases. Other countries, such as Australia, have a ~60% prevalence of AK due to their proximity to the equator. President Donald Trump moved to the Sunshine State in 2018.

How Doctors Treat Actinic Keratosis

To minimize the risk of AK progressing into squamous cell carcinoma or other types of skin cancer, doctors may recommend a variety of treatment options. The first category, lesion-directed therapy, focuses on individual actinic lesions. The second category, field-directed therapy, targets multiple areas affected by actinic keratoses that lie beneath the skin and are not visible to the naked eye.

Lesion-directed treatments include:

    Cryotherapy – Liquid nitrogen is applied directly onto the lesion to freeze and destroy it

Curettage – The lesion is scraped away using a small surgical tool

    Surgery – The lesion is surgically removed; typically considered when cancer is suspected, or the diagnosis is uncertain

Field-directed treatments include:

       Dermabrasion – Superficial layers of skin are removed using an abrasive mechanical device

      Laser therapy – The outer layer of skin is vaporized using a focused light beam

      Chemical peels – An acid solution is applied to the skin to remove the damaged outer layer

     Photodynamic therapy (PDT) – A light-sensitive drug is applied to the skin, then activated by a light source to destroy abnormal cells      

Topical medication – Creams and gels applied directly to the skin to destroy abnormal cells

The most common field-directed treatment is 5-Fluorouracil (5-FU), which is believed to be what President Trump's physician prescribed. The ointment is applied one to two times daily for several weeks. 5-FU is known to cause redness, inflammation, crusting, and a burning sensation when applied to the skin— consistent with the irritation visible on President Trump's neck. After treatment, healthy skin begins to appear within one to four weeks of stopping treatment.

How to Protect Your Skin

An AK diagnosis isn't a life sentence. Early detection and preventative steps can significantly lower your risk of skin cancer and prevent further damage.

Dermatologists suggest the following:

●      Use broad-spectrum SPF 30 or higher sunscreen every day — water-resistant is best

●      Reapply sunscreen every two hours

●      Reduce time in the sun — less UV exposure means less skin damage

●      Avoid tanning beds — artificial UV light still damages skin and raises cancer risk

●      Wear protective clothing: wide-brimmed hats, long sleeves, pants, and sunglasses

●      Schedule regular skin checks with a dermatologist to catch any changes early

See a Doctor Before It Becomes Something More

The sun or tanning beds have damaged your skin — that's what an Actinic Keratosis diagnosis tells you. Treat it early, and you can stop AK from progressing into squamous cell carcinoma. Simple daily habits — such as protecting your skin from the sun — lower your chances of AK coming back, though your doctor may need to treat you more than once.

Everyone who has a fair complexion, spends extended periods exposed to UV rays, and skips sunscreen is at risk for AK — including, it seems, the President of the United States. If you are over 40 and have some of the risk factors, contact a dermatologist. They can assess your skin, provide treatment, and advise you on how often to perform self-exams.

AKs are deceptively dangerous — easy to dismiss as annoying skin growths when they are, in fact, precancerous lesions. See a doctor, follow their advice, and keep your skin healthy.

References

5 facts you should know about precancerous skin growths. (2023, July 17). Www.aad.org. https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-facts-about-precancerous-skin-growths

Actinic keratosis: Self-care. (2026). Aad.org. https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-self-care?_gl=1

Bain, J. (2025, May 5). Actinic Keratosis: Put Your Finger on the Problem! - The Skin Cancer Foundation. The Skin Cancer Foundation. https://www.skincancer.org/blog/actinic-keratosis-put-your-finger-on-the-problem/

Good Genes Or Tanning Beds: Why Is Donald Trump Orange? (2024, December 9). Grazia. https://graziadaily.co.uk/life/in-the-news/why-is-donald-trump-orange/

Johns Hopkins Medicine. (n.d.). Actinic Keratosis (A Precancerous Condition). Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/actinic-keratosis

Marques, E., & Chen, T. M. (2020). Actinic Keratosis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557401/

Van Beusekom, M. (2024, July 18). Center for Infectious Disease Research and Policy. CIDRAP. https://www.cidrap.umn.edu/covid-19/study-covid-can-trigger-changes-immune-system-may-underlie-persistent-symptoms

Vanaria, R. J., Chaudry, A., & Nestor, M. S. (2025). Nonmelanoma Skin Cancer in South Florida: A Change in the Relative Incidence of Basal and Squamous Cell Carcinoma. The Journal of Clinical and Aesthetic Dermatology, 18(11), 12. https://pmc.ncbi.nlm.nih.gov/articles/PMC12724980/

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