Under the midnight sun: A case of actinic keratoses in an avid Inuit fisherman

We report the case of a 74-year-old Inuit man from Kangiqsualujjuaq, Quebec, with a 10-year history of persistent facial skin changes, reported as “dry skin.” Examination revealed violaceous scaly papules on sun-exposed areas that had sandpaper texture on palpation. The patient, with no significant medical history, spends extensive time outdoors in a subarctic environment. A diagnosis of actinic keratoses was made. This case highlights the need to recognize atypical presentations of actinic keratoses in patients with darker skin phototypes and high environmental ultraviolet exposure. Topical 5% fluorouracil was initiated.