Actinic keratoses (AKs) are lesions caused by chronic UV radiations that have the potential to progress to invasive SCCs. The prevalence of AK is increasing worldwide, and although there are a variety of treatment modalities, along with a number of published guidelines, there is a lack of advice on treatment recommendations for AK in clinical practice. There are also considerable variations in the care of patients with AK in Europe, and so the Skin Academy (a group of leading experts in the field of dermatology and skin cancer) formed to discuss best practice in the treatment of AK. The result of these discussions is an algorithm designed to assist physicians with their treatment decisions, giving recommendations for both field directed and lesion directed treatment. The new AK Treatment Algorithm described in this paper comprises 5 key, decision making steps, which are simple and allow the flexibility to reflect cultural differences between and within countries. The algorithm also considers factors such as patient profile, medical history, and personal preference (eg cosmesis, and pain). This is a novel algorithm that has the capacity to grow and expand as more clinical evidence becomes available. It offers, for the first time, a summary of European best practice recommendations for the treatment of AK.