What are the Spots on the face?

It happens to everyone sooner or later. A casual glance in a mirror turns into a lengthy self-examination. Is that a new mole? Old photographs and the internet are consulted. Visions of skin biopsies dance in one’s head.

Even those who take meticulous care of their skin are likely to develop age- or sun-related imperfections as they grow older. And for many, any new mark or mole kindles skin-cancer concerns. For good reason: Skin cancer is the most common form of cancer in the U.S. While the majority of skin cancers are basal cell or squamous cell carcinomas (types that are almost never lethal), the incidence of deadly melanoma skin cancer is on the rise and has been for decades. According to figures from the American Academy of Dermatology, one in 27 men and one in 40 women will develop melanoma at some point in their lifetime.

But while skin cancers are increasingly common, a new mole or mark is much likelier to be the benign result of either age- or sun-related damage. Dermatologists say these “age spots” come in four common types. Each of the four has a few defining characteristics, and they all tend to start showing up during a person’s thirties — though they can appear at younger ages.

The first two have nothing to do with sun exposure and everything to do with growing older, says Suzanne Olbricht, dermatologist-in-chief at Beth Israel Deaconess Medical Center in Boston. One type is called a cherry angioma. These are bright red or bluish-red raised bumps that tend to be about the size of the tip of a crayon — although they can be bigger. They can show up anywhere, but are most common on the trunk and scalp. “They’re big tangles of blood vessels,” Olbricht explains. While doctors aren’t sure why they form, most people in their thirties have at least one or two of them, and nearly everyone develops a handful or more as they grow older.

The second type of age spot is known as seborrheic keratosis. “We call these stuck-ons, because they look like they’re stuck on the skin like a piece of gum,” Olbricht says. These “warty looking” moles tend to be a shade of brown, are uniform in color, and often appear waxy or scaly, she says. Once again, doctors aren’t sure why they form — though they tend to run in families. While these and cherry angiomas are harmless, a dermatologist can freeze, cut, or laser them off if people feel they’re unsightly, she says.

The other two common types actually have little to do with age, and everything to do with sun damage. The first of these are known as actinic or solar keratosis, and they’re small patches of crusty or rough skin that usually develop on parts of the body that are exposed to the sun — such as the hands, face, ears, hands, and neck. “They tend to have a gritty scale on top that feels like sandpaper,” Olbricht says. These can itch or burn, and the skin beneath the scaly patch is usually red. Sun-related mutations in the cells of the skin cause actinic keratoses (AKs) to form — usually in people who are 40 and older. And while they’re typically harmless, roughly 5% to 10% of AKs evolve into squamous cell skin cancers, according to the nonprofit Skin Cancer Foundation. For this reason, it’s a good idea to talk with a doctor if you develop one or more AKs. In some cases, these can be frozen off or removed using a chemical peel. But mostly, you want your doctor to be aware of them so he or she can keep an eye out for squamous cell carcinomas.

Even those who take meticulous care of their skin are likely to develop age- or sun-related marks as they grow older.

Finally, one of the most common types of age spots is called a solar lentigo. These are flat marks that tend to be a shade of brown, and show up in sun-exposed parts of the skin. “These spots are a result of the body producing excess melanin, which is the pigment that gives skin its color,” says Adam Friedman, a professor and interim dermatology chair at George Washington University. With age and accumulated sun exposure, the specialized cells that produce melanin — which are called melanocytes — can become dysfunctional. This dysfunction can cause them to discharge excess melanin. “Lentigines appear when excess melanin in the skin becomes clumped together,” Friedman says.

“They are totally benign and harmless,” adds Debra Jaliman, an assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City, of solar lentigines. People who have light skin or lots of freckles are prone to developing these. But they can show up on anyone who gets a lot of sun exposure. “Once they form, they can darken or they can grow,” she says. “They can be removed with lasers, and they can also be lightened with skin lightening prescription creams or some over-the-counter creams that contain niacinamide.”

Unfortunately, it can be difficult to differentiate solar lentigines and other benign skin marks from skin cancers. Friedman says that even a dermatologist wielding a dermatoscopy —basically, a specially designed magnifying glass — may not be able to determine whether a new mole is cancerous. “When in doubt, we perform a biopsy,” he says.

Long story short, if you spot a new mole, there’s a good chance it’s not a threat to your health. But the mark could be cancerous, and you really won’t know it unless you have it checked out by a doctor. A skin doctor may also be able to help you lighten the new mole’s appearance or remove it altogether.

“Especially if it’s something that’s changing or growing, you should show it to a dermatologist,” Olbricht says.

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