Is a small rough whitish patch of skin always actinic keratosis?

Lots is possible. In addition to everything that dr. Lee mentioned, it could also be a white nevus. There are so many possibilities (some of them very worrisome, some not), you want to get it check out.

Related Questions

Is it possible to get actinic keratosis on an area of skin that has had little sun damage?

Yes. It is common on face, scalp and arms, but can oocur on the legs, back or. Chest. Sun is major factor but light skin color and weakened local immune system are also factors. These are treatable with cream, cryosurgery, electrosurgery. Read more...
Actinic keratosis . Generally actinic keratoses are found on areas with chronic sun exposure such as the scalp, face, ears, neck, upper trunk, arms , back of hands , legs and top of feet. Read more...
Rarely . Sun damage is the cause of actinic keratoses but the damage may have occurred decades prior to the onset of lesions. Read more...

Had a skin biopsy of nose that said actinic keratosis with dilated pore of winer. How likely is this to be wrong and be a Squamous Cell Carcinoma?

Why do you ask? This is one of the most basic calls for a pathologist. It is like asking a zookeeper to identify an elephant. If you are worried for whatever reason, ask for a second pathologist to sign off. Read more...