This review discusses recent progress in actinic keratosis (AK) management, highlighting therapeutic breakthroughs, pathophysiological discoveries, and program implementation strategies. This article also explores advances in photodynamic therapy, introduces new topical treatments, and details the genomic and transcriptomic pathways from AK to squamous cell carcinoma, including the role of the cutaneous microbiome. Studies aiming to improve diagnosis, adherence, and patient-focused care are also reviewed. Together, these insights encourage a move toward personalized, technology-enhanced approaches in AK treatment, aiming to better patient outcomes and prevent the escalation to more severe skin cancers.