Ms. Zhang rarely sunbathes, yet mysterious brown spots appeared on her body, causing her concern.
Ms. Li noticed an oddly shaped mole under her big toenail, suspecting malignant melanoma. A doctor diagnosed it as common bruising.
Some dismiss skin spots as harmless, while others fear they signal disease.
Dermatologists explain that most spots—including sunspots, age spots, and freckles—are linked to sun exposure, aging, or individual constitution.
Spots related to sun exposure or genetics typically pose no health concerns.
Young People Can Develop Age Spots
Age spots, formally known as seborrheic keratoses, are often mistakenly believed to affect only the elderly.
Seborrheic keratoses are benign growths of the keratin and epidermal layers accompanied by increased pigmentation. Brown, raised bumps appear on the face, typically linked to sun exposure and aging.Some young individuals develop them on the chest, abdomen, or back due to constitutional factors.
Freckles and sunspots share a similar appearance, influenced by ethnicity or constitution. Westerners with fairer skin often develop numerous freckles on their faces during adolescence. Dr. Zhuang Yahui notes that the same type of spot may be affected by different factors—for instance, freckles can become more pronounced with sun exposure.
Other clinically common spots include melasma, Nevus of Ota, Nevus of the cheekbone, and Nevus of Becker.
Nevus of the cheekbone typically appears on the cheekbones, commonly seen in Asians and linked to genetics. Rubidium chromium laser treatment may temporarily lighten it, but complete removal is challenging.
A small number of individuals are born with a blue-gray birthmark covering one side of the face, known as Nevus of Ota. If this significantly impacts the child's appearance and psychological development, ruby or rubidium-yttrium-aluminum-garnet laser treatment may be recommended.
Beck's nevus typically appears on the chest, back, and upper limbs as brown patches, sometimes with hair growth. Multiple laser sessions are often required for fading, and recurrence is common.For patients seeking improvement, Dr. Chuang suggests considering ruby or YAG laser treatments. If hair removal is also desired, Alexandrite or diode lasers are viable options.
Nevus of Ota and Nevus of Becker are benign birthmarks linked to genetic factors during embryonic development. Sunspots, age spots, freckles, and malar macules are also benign and pose no health risks. Unless cosmetic concerns arise, they typically require no special treatment.
Chloasma has no connection to liver issues; taking liver-protecting medications is ineffective.
Many people mistakenly believe chloasma results from liver problems based on its name. One woman even took excessive liver-protecting drugs after developing chloasma on her cheeks. In reality, the condition is named for its resemblance to the color of liver.
The primary cause of melasma is constitutional predisposition, with women being more susceptible. Chen Xuanxiang notes that some women who had minimal or no melasma before pregnancy develop it afterward. Beyond pregnancy, hormonal changes from oral contraceptives can also trigger melasma. While melasma may fade slightly postpartum, it rarely disappears completely and may recur in subsequent pregnancies.
Fade creams are not a panacea
For those genuinely concerned about melasma, Dr. Chen recommends using a triple-action topical medication containing steroids, hydroquinone, and vitamin A acid under medical supervision. Consistent application for 4–8 weeks can yield significant fading results. However, self-purchasing such creams from pharmacies or cosmetic stores is discouraged, as incorrect timing or dosage may cause skin allergies or damage.
These creams are generally effective only for superficial spots like freckles and melasma. For deeper conditions like Nevus of Ota or Nevus of the cheekbone, laser treatment is required to fade them.
Does having more spots increase skin cancer risk?
Judging cancer probability solely by spot count is challenging. Dr. Zhuang Ya-hui notes that some individuals with few facial spots may suddenly develop a spot-like malignant mole, which could be skin cancer.
Age, constitution, and prolonged excessive sun exposure increase the risk of skin cancer, especially with more sunspots and seborrheic keratoses.
Post-inflammatory hyperpigmentation isn't actually a spot
Beyond the common spots mentioned, post-inflammatory hyperpigmentation is often mistaken for dark spots.
Some refer to this as post-inflammatory hyperpigmentation, though it doesn't fit the medical definition of a spot. Examples include trauma from falls, scrapes, surgeries, acne, eczema, or insect bites. These inflammatory events cause epidermal melanin to migrate into the dermis, leaving a darkened discoloration at the wound site.
Another cause is phytophotodermatitis, where certain plants trigger inflammation followed by pigmentation.
Some plants contain photosensitive compounds. If lemon or citrus juice comes into contact with skin that is then exposed to sunlight, it can cause itching or the appearance of spots.Chen Xuanxiang noted that consuming photosensitizing foods like basil, celery, and cilantro before sun exposure may also trigger photosensitive hyperpigmentation.
Immediately washing skin after contact with photosensitizing plant juices and avoiding sun exposure can reduce the risk of phytophotodermatitis.
For those deeply concerned about dark spots or pigmentation but hesitant about potential treatment scars, non-invasive phototherapy options like pulsed light or skin-clearing lasers may be considered. However, she also noted that some individuals may experience post-inflammatory hyperpigmentation or uneven skin tone after laser treatments. Patients should consult a dermatologist beforehand for an assessment of their individual constitution, treatment plan, and associated risks to avoid unnecessary side effects.
The Hidden Danger in Spots: Malignant Tumors Resembling Moles
While most spots result from long-term sun exposure, constitution, or aging, Dr. Chuang cautions that a sudden proliferation of seborrheic keratoses within weeks or months, or significant changes in spot appearance, may indicate underlying adenocarcinoma tumors requiring special attention.
Caucasians exhibit higher rates of malignant melanoma, which can develop on the face or body. International studies indicate that many white individuals increase their melanoma risk through inadequate sun protection, frequent sunbathing, or tanning salon use to achieve a bronze complexion.
While Asians have a lower incidence of malignant melanoma than Westerners, it more commonly appears on the extremities—such as the palms, soles, or under the nails—with a higher prevalence in these areas. Dr. Chen Hsuan-hsiang suggests this may be related to ethnicity and constitutional factors.
Malignant melanoma often resembles a spot or mole in its early stages, leading some to overlook it and delay treatment. By the time severe ulceration or lumps appear, it may have already metastasized to lymph nodes or other organs.
How can you tell if it's a spot or skin cancer?
How can you tell if you have malignant melanoma?
When an uncertain mole appears, use these five criteria to assess its appearance.
Another skin lesion to watch for is basal cell carcinoma, linked to prolonged sun exposure. It resembles a mole and may blend with other facial spots.Some people ignore it until they notice skin ulceration, by which point the basal cell carcinoma has penetrated beneath the skin, invading bone or muscle and destroying healthy tissue.
If you observe a raised, saucer-shaped border around a mole with a central ulceration, pearlescent or brownish discoloration, it could be basal cell carcinoma—the type diagnosed in actor Hugh Jackman.However, these cancer cells rarely metastasize. Early detection and complete removal typically yield favorable outcomes.
Neglecting actinic keratosis risks progression to squamous cell carcinoma
Actinic keratosis is often mistaken for sunspots or seborrheic keratosis. Individuals with numerous age spots on their face may find actinic keratosis mixed among them. If a patch of skin feels unusually dry and coarse, has cracked skin, or appears red and doesn't improve with topical treatments, it could be actinic keratosis.Actinic keratosis is a lesion located in the epidermal layer of the skin. If left untreated for a long time, it can gradually proliferate and form a lump, eventually becoming squamous cell carcinoma.
Actinic keratosis is akin to a precancerous stage of skin cancer, as some squamous cell carcinomas originate from it. Beyond prolonged sun exposure, factors like burns or chronic ulcers can also contribute to squamous cell carcinoma development.