Some spots caused by aging and sun exposure are benign, while others need medical attention. Learn the difference.
If you've recently spent any time in the sun, you may have noticed that you have a few more spots—brown or tan or white—on the exposed parts of your body. Even if you always use sun protection now, you can still develop skin changes caused by sun exposure decades ago. The good news is that most of these will not be cancerous. However, distinguishing benign spots from those that warrant medical attention can be somewhat tricky. Though the following are caused by sun exposure, they won't progress to cancer.
If you've had freckles since you were a kid, you no doubt know how they behave—darkening in the sun and heat and fading in the winter. Freckles themselves are not a cause for worry, but they signal an increased risk of developing skin cancer.
This condition, marked by irregular dark patches, is more common in women and may appear in one's 20s and 30s. The patches are often triggered by excessive sun exposure and intensified by changes in hormone levels associated with contraceptives, pregnancy, or postmenopausal hormone therapy. Low levels of thyroid hormone may also contribute. Melasma can affect people with all skin types and become darker with sun exposure. It may disappear during menopause as estrogen and progesterone levels decline.
These are commonly called "age spots" or "liver spots." They are irregular in shape, larger than freckles, and vary from tan to very dark brown. They occur in sun-exposed skin. Some are direct consequences of severe sunburns. They are common in people of all skin types.
4. Seborrheic keratoses
These are usually round, dark, and raised. They are often described as appearing to be stuck on, like a piece of gum. If you're unsure whether you have a seborrheic keratosis or a melanoma, see a dermatologist.
5. "White spots"
The medical term for these small smooth spots is idiopathic guttate hypo-melanoses. Women are more likely than men to have this condition and usually develop it after age 40, usually on areas of the body exposed to the sun.
What should you do about them?
There is no medical reason to treat any of the above, but scores of over-the-counter products are promoted for reducing the appearance of dark spots or improving skin tone. This is a buyer-beware situation, because these products are cosmetics rather than prescription drugs, their manufacturers don't have to demonstrate their effectiveness.
However, dermatologists have several proven techniques for treating dark and light skin patches, including chemical peels and prescription ointments containing hydroquinone or retinoic acid. Laser therapy can be effective for dark spots. All of these treatments are considered cosmetic, so your insurance won't pay for them.
When to see a dermatologist
Check your skin regularly for moles that are new, growing, changing, or irregular in shape and color. They could be a sign of melanoma, the deadliest skin cancer, and should be checked by a dermatologist as soon as possible. If melanoma runs in your family or if you have more than 40 moles, have used tanning beds, or have had several sunburns, you're at increased risk and should have your skin checked regularly by a dermatologist.
Solar, or actinic, keratoses also warrant a trip to the dermatologist because they can progress to a form of cancer called squamous cell carcinoma. They are red, pink, tan, or clear bumps that often feel rough or scaly. They may also appear as sandpapery patches that are hard to distinguish from the surrounding skin, except by touch. Although not quite as deadly as melanoma, squamous cell skin cancer can grow deep into surrounding tissue and can occasionally spread to other parts of the body.
You should see a dermatologist if you find any new growths or skin changes that last for more than a couple of weeks. The American Academy of Dermatology's website has tools to help you spot suspicious growths. Go to www.aad.org and click "Spot skin cancer."
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