Actinic keratosis (AK) is a chronic, progressive disease of the skin that has undergone long-term sun exposure. The affected areas contain visible and subclinical nonvisible sun damage resulting in epidermal keratinocyte dysplasia, known by many as ‘field cancerisation’ (1), which is prone to AKs and sun-related skin cancer (2). Thus, visible AKs are clinical biomarkers for a photo-damaged field with subclinical damage associated with the unpredictable risk of progression to invasive squamous cell carcinoma (iSCC) (3). The aim of this multiexpert opinion article is to provide a discussion succinctly highlighting the clinical gaps for optimal management of AK: the lack of a universal definition and the need for a standardised grade assessment of AK/field cancerisation that also takes into account individual risk.