Pigmented spots are among the most common skin findings. Freckles are small, flat, light-brown or reddish-brown dots caused by localized increases in melanin.
They are strongly genetic; appear early in life, especially in fair-skinned people; darken after sun exposure; and often fade in winter. Freckles themselves are entirely benign.
Sunspots, also known as solar lentigines or age spots, are larger, flat, sharply bordered tan-to-dark-brown patches that result from cumulative ultraviolet damage.
They become more numerous with age, and do not fade significantly seasonally. Pure solar lentigines are harmless, though the sun damage that creates them elevates overall skin-cancer risk.
Ordinary moles, or nevi, are usually round or oval, uniform in color, and stable for years. Seborrheic keratoses, also known as barnacles, are waxy, stuck-on brown growths that also increase with age and are benign. Atypical moles may show mild irregularity and warrant closer watching.
Melanoma and some pigmented basal-cell carcinomas can begin as or mimic ordinary spots. Apply the ABCDE rule to identify the early warning signs of melanoma:
One lesion that looks distinctly different from all the others is equally important. An outlier spot should always be evaluated, even if it does not meet every ABCDE criterion.
Meanwhile, it is time to schedule a visit to a dermatologist if you observe any of these warning signs:
1.Symptomatic changes
2.Non-healing sores
3.New spots in adulthood, specifically after age 30 or 40
4.Textural changes and scaly lesions that cannot be managed with cosmetic topicals
5.Asymmetric spread
A dermatologist first performs a comprehensive skin examination and medical history review, using specialized diagnostic tools – like a dermoscopy or Wood’s lamp – to assess whether pigment sits in the superficial or deeper skin layers.
If any spot appears atypical or displays suspicious signs, the dermatologist performs a skin biopsy for a definitive diagnosis. Spots confirmed to be malignant require complete surgical excision with pathological margin verification to ensure local disease clearance, whereas benign freckles and sunspots can be left alone or treated cosmetically alongside strict daily sun protection guidance.
Regular self-checks plus professional evaluation of anything that changes keep that map safe.
Dr Ngan Pui-yan, Specialist in Dermatology and Venereology
