New spots and lesions appearing on your skin, especially after sun exposure, can be alarming.
While often harmless age spots, these pigmented areas could also signal melanoma, a form of skin cancer.
According to the NHS, the main cause of melanoma is ultraviolet light, which comes from the sun and is used in sunbeds.
There are many factors that increase your chances of getting melanoma. Because spots and lesions appear strikingly similar, knowing the difference is crucial.
With May being Melanoma Awareness Month, this is how you can tell if a new mark is merely a cosmetic blemish or requires immediate medical attention.
How to spot the difference
While the two look alike, age spots are totally harmless in comparison to melanoma.
“Age spots – also known as sunspots and liver spots – are flat, brown areas on sun-exposed areas of the skin,” explains consultant dermatologist at Nuffield Health, Dr Chris Harland. “Dermatologists refer to them as solar lentigos.”
They are most common in adults with fair skin over the age of 50, and particularly for those who have spent a lot of time in the sun.
While direct sun exposure is the most common cause of age spots, tanning beds can also cause them.
“Age spots are usually flat and smooth and less than a centimetre in diameter,” says Harland. “I find it useful to reassure patients that when they develop a light brown flat spot, which is the colour of coffee with added milk, then it is very likely to be safe.”
However, it can be tricky to tell them apart when lentigos show different shades of brown.
“Melanomas – which are much rarer – can occur as flat spreading, irregular and dark or even black spots,” says Harland. “They may have at least two shades of brown, black or even pink.
“Whilst safe when flat, they can become lumpy (invasive) and dangerous.”
He advises anyone with suspicious lesions to be checked by a GP or dermatologist, who can use a specialised microscope called a dermascope.
Can age spots become cancerous?
While age spots are harmless, they can develop into something more serious.
“Age spots can change and they can see benign changes and cancerous ones,” explains national dermatology lead at Nuffield Health, Dr Unnati Desai.
“Benign changes can include non-cancerous thickened and/or rough textures,” she says.
“Cancerous changes, also known as lentigo maligna, a precursor to melanoma, and lentigo maligna melanoma, often start with what looks like a benign age spot but will change to have an atypical look such as a larger size, irregular shape, changed texture or height or have multiple colours – like tan, dark brown, black, pink, red and white.
“It’s also important to look out for ulceration and bleeding.”
It’s crucial to therefore regularly check any age spots or lesions that may previously have been diagnosed as benign.
When to see a dermatologist
If you notice any changes in existing lesions or new ones appear, consult a medical professional.
“One of the easiest ways to check for potential signs of melanoma is by using the ABCDE rule,” explains Dr Desai.
“A is for asymmetry in the shape. B is for a border that is irregular. C is colour that is uneven, or contains different colours – like black, brown or pink. D is diameter, such as increases in size and E is for elevation and evolution, where the lesion becomes raised off the skin or changes in any other way such as bleeding, or becoming crusty, itchy, ulcerated, or inflamed.”
“I also recommend taking pictures of any concern areas every three to six months, comparing the latest with the previous images to monitor the skin and any changes. If any changes are noticed by the naked eye, then see a doctor for an examination with a dermascope,” she says.
How your beauty treatments can affect melanoma
You may want to treat pigmentation with lasers, creams or masks. But some beauty treatments could interfere with the identification of a melanoma.
“Before treating any skin lesion, you should consult your doctor for an appropriate examination – usually with a dermascope or biopsy – to ensure there are no features suggestive of skin cancer,” explains Desai.
This is particularly important if the treatment involves destroying the cells. “Following any treatment, a review with your doctor is recommended to monitor any recurrence or abnormal healing,” she says.
“Creams, such as retinoids and hydroquinone, have a limited effect on the cosmetic appearance of age spots,” says Dr Harland. “Gentle freezing – known as cryotherapy, laser or intense pulsed light can remove them.
“However, these cosmetic treatments are not available through the NHS and can be expensive,” he says. “Treated lesions may also recur.”
Protection and prevention
While wearing daily SPF is more or less commonplace nowadays, there are some key things to bear in mind when protecting your skin and preventing melanoma.
“From an early age it is important to avoid sun burn, especially for those with fair skin,” says Harland. “However, age spots are associated with an overall lifetime exposure to ultraviolet, not just sun burns, so a good level of protection will help prevent them occurring.”
Using a good mineral or chemical SPF daily is the most important thing you can do to prevent both age spots and melanoma.
“This means using a daily sunblock, even in the winter months,” says Desai. “Use a sunscreen with a star rating of three to five, protecting from UVA radiation and an SPF rating of 30-50 protecting from UVB radiation.”
Look for ingredients like zinc oxide and titanium dioxide – found in mineral sunscreens – which act as physical UV barriers.
“In the summer months, an SPF minimum of 30 is needed, especially if you’re sitting or lying in the sunlight,” says Desai. “When going abroad to warmer climates, this should be a minimum of an SPF 50. Wear clothes that cover the skin if spending a longer period of time outdoors.
“In winter months, an SPF of 12 to 15 is adequate for day-to-day use.”
