Freckles from the sun

Mayo Clinic Q and A: All about freckles

DEAR MAYO CLINIC: Over the past year, I have developed a number of small brown blotches on my face that darken when I’m in the sun. The spots lightened a bit over the winter, but I’m concerned they will darken again this summer. What causes this, and is there a way to avoid it from worsening? I am 25 and otherwise healthy.

ANSWER: What you are describing sounds like ephelides — also known as freckles. These small areas of extra pigmentation on the skin get darker when they are exposed to sunlight during the summer, and then they tend to fade during the winter. Freckles typically are not a sign of an underlying skin disorder, and they do not require any treatment. Check them from time to time, though. If you notice any changes, such as one of the spots growing larger or developing an irregular border, see a dermatologist to have it checked.

Ephelides most often appear tan, brown or red. Unlike some other dark skin patches, such as moles, they are flat rather than raised from the skin. Freckles are most common in people with fair skin and in those who have red hair. Freckles generally develop in childhood, adolescence or young adulthood, and they may increase in number and distribution during that time.

A hallmark characteristic of freckles is that they get darker when exposed to the sun’s ultraviolet (UV) light. That’s why they become more noticeable in the summertime and fade throughout the winter months.

In some case, freckles may be confused with another type of skin spot known as solar lentigines — sometimes called age spots. The difference is that solar lentigines are actually caused by frequent and prolonged sun exposure over the course of many years. Freckles, on the other hand, are typically a result of genetics. Freckles often fade or disappear with age, while solar lentigines become more common as people get older.

You can help keep freckles from getting darker, and reduce the likelihood that more will appear, by taking steps to shield your skin from sunlight, especially during the summer months.

Use a broad-spectrum sunscreen with a sun protection factor, or SPF, of 30 or higher whenever you are outdoors. Wear sunscreen — even if the sun is not shining, as UV light penetrates through clouds and reflects off water, snow and other surfaces. Apply sunscreen generously and frequently to all areas of exposed skin, particularly after you have been swimming or sweating.

To further shield your skin from the sun’s damaging rays, wear protective gear, such as a broad-brimmed hat and sunglasses, and limit your time outdoors when the sun is strongest during the late morning and early afternoon. Never use a tanning bed.

Although freckles are harmless, it is important to keep an eye on skin changes and be familiar with what’s normal for your skin. Skin cancer is one of the most common types of cancer, so know its signs and symptoms. If you notice anything out of the ordinary, see a dermatologist.

In particular, watch for new dark patches appearing on your skin that have not been there before. Notice if a patch of skin changes color; becomes darker in only one area; becomes uneven, jagged or scalloped around the edges; grows larger; or changes in height. If any of that happens, see a dermatologist. If a darker area of skin bleeds, itches or becomes tender, evaluate that promptly, too. — Dr. Julio Sartori Valinotti, Dermatology, Mayo Clinic, Rochester, Minnesota

Appliance of Science: How and why do we get freckles?

This question was sent in by seven year old Daniel; he would like to know… how and why do we get freckles?

Freckles are fairly common, especially in people with fair
complexions but people with darker complexions can get them too.
Before we look at how and why they appear, we need to first consider what they are?

WHAT ARE FECKLES?

Freckles are small spots on the skin, they are usually tan or light brown in colour. Unlike moles or some birth marks, freckles are flat on our skin. Freckles are completely natural and harmless.

We are used to seeing them on peoples’ faces but they can be found all over the body. Although it is rare, some people even have freckles on the palm of their hand or sole of their foot.

Freckles often become more obvious or more abundant when we expose our skin to the sun and that gives us the first clue as to why they appear. Most freckles disappear after a while, particularly when our skin is not exposed to as much sunlight.

NATURAL SUN SCREEN

Freckles are the result of a natural colour (or pigment) called melanin produced by the body to protect the skin against the harmful rays of the sun.

This process is called photoprotection and this is how it works… When UV rays of light from the sun hit our skin they trigger certain cells in our body to make more melanin. The cells that make the melanin are called melanocytes. The melanin is sent to the outer layer of our skin where it absorbs these harmful UV rays, protecting the skin cells (and the cells’ DNA) from their damage.

Usually melanin is distributed evenly around the parts of the skin that are exposed to the sun, causing our skin to tan. Sometimes though, the melanin clumps together in small areas, forming little dark spots that we call freckles.

Freckles can also be due to small areas of skin where the melanocytes produce too much melanin.

We have a lot less melanocytes in the skin of our palms and the soles of our feet, which is why we don’t tan in these areas. It is also why freckles are rare on these parts of our body.

CAN ANYONE GET FRECKLES?

Freckles are certainly very common among people with fair complexions. They also tend to be more noticeable on fair skinned people, but people with all types of skin tones can get them. Freckles tend to run in families, so if your parents have them there is a good chance you do too. The tendency to get freckles is linked to a gene called MC1R.

WHEN IS A FRECKLE NOT A FRECKLE?

Moles and birthmarks tend to be darker than freckles and may also be slightly raised.

Dermatosis papulosa nigra (DPN) is common among darker skinned people although all skin tones can have these spots; they appears as dark spots on the skin, often on the face.

Although they look very like freckles, or moles, they are actually different, although they are also harmless. Lentigines are tan spots on the skin that often appear later in life. Freckles frequently decline as we age.

Naomi Lavelle is a science communicator and mother to three inquisitive children. She can be found at sciencewows.ie. Email your questions to [email protected]

Freckles: Everything You Need to Know in 1 Minute

A freckled complexion is one of the latest North American beauty trends, popularized by celebrities like Emma Stone, Emma Watson, and Julianne Moore. Some women have even gone to the lengths of having freckle-like marks tattooed on their faces. East Asian women may not be fond of this North American trend, however, being known to prefer clear, pale complexions. Whether you like them or not, freckles are a phenomenon that often sparks curiosity. Have you ever wondered what freckles are and what causes them? The answer lies in your genes.

Skin color is determined by the amount of melanin in your skin; the more melanin you have, the darker your skin will be. Sometimes melanin can be more concentrated in certain skin cells, resulting in freckles. This explains why freckles darken upon exposure to UV rays from the sun. UV exposure causes certain skin cells to produce melanin, making skin (including freckles) appear darker. In the same way that you inherit your hair and eye color from your parents, you can inherit freckles. In fact, scientists have identified several genes that are known to cause freckles. One of the most well-known ones is called MC1R.¹ Sometimes this gene is referred to as the “red hair gene”, which explains why red hair and freckles often go hand in hand.

It’s important to distinguish between freckles, sun spots, and moles. Freckles, also known as ephelides, first develop at about 2-3 years of age. Freckles sometimes fade with age, and can darken or lighten depending on sun exposure. Age spots, also known as lentigines, are seen much later in life, usually after 50 years of age. These spots are caused by accumulated sun exposure rather than genetic factors, and these spots don’t typically fade.¹ Moles are also caused by skin cells with higher concentrations of melanin; however, these spots tend to be permanent and don’t change throughout life.²

Freckles, moles, and age spots aren’t inherent health concerns, but they should be monitored for abnormal changes. If you notice any suspicious changes in the border, colour, or size of a spot on your skin, seek the advice of a dermatologist. Freckles can darken upon exposure to UV rays from the sun. You can use QSun to make sure you’re staying safe in the sun. Available for iOS and Android, the free app gives you personalized sun safety tips, such as how much sunscreen to apply and sunscreen reminders. It even tells you how long you can stay outside before getting a sunburn.

Sources:

Do Freckles = Skin Cancer?

Q1. I’ve always had freckles, but I’ve noticed that an alarming number of new ones have popped up all over my face and chest. Could this be a sign of sun damage or skin cancer?

Freckles (“ephelids”) are a sign of previous sun exposure. While most freckles are not dangerous, they are an indication of sun damage. Freckles develop when the skin produces more melanin pigment in response to the sun’s ultraviolet (UV) rays. Think of this process as your skin’s attempt to protect itself from further sun damage. This is why freckles often fade in the winter, then darken in the summer, when there’s more sunlight.

Freckles are more common in fair-skinned individuals, who tend to sunburn easily and have difficulty tanning, while those with olive or darker skin tones can tan easily and have fewer freckles. Freckles usually begin appearing in childhood on areas of the body that are most exposed to sunlight (like the face, chest, and arms), and gradually accumulate over a lifetime of sun exposure.

A recent sunburn or visit to a tanning bed could trigger the onset of new freckles. In fact, freckles that appear after a sunburn (“sunburn freckles”) have been associated with an increased risk of melanoma skin cancer. These are most often found on the chest and shoulders, and are larger and darker than the light brown freckles seen in childhood.

Any change in your freckles or moles could be a sign of skin cancer or a precancerous condition, so I recommend a visit to your dermatologist, who can examine your new freckles and determine whether they need to be removed. In my office, I encourage my patients to have a complete skin examination at least once a year for a baseline, and to come in sooner if they notice any changes in their skin, such as new growths or existing growths that are getting larger, darker, or itch and/or bleed. Freckles or moles that show these changes may need to be removed and sent to a lab for a biopsy to determine whether they are cancerous.

Q2. I need to buy sunscreen, but I’m confused by all the options. How high an SPF do I really need to protect my skin?

It’s more important than ever to use the right sun protection. Like you, a lot of my patients are confused by the many available sunscreens. Pricier department store products aren’t necessarily better than drugstore brands — luckily, there are good options at any price, but you should know what features to look for.

First, a quick lesson on SPF: SPF stands for sun protection factor, which is a measure of the amount of time you can spend in the sun before getting a sunburn. For example, if you would normally burn after 10 minutes, a sunscreen with SPF 15 should allow you to stay out for 150 minutes before burning. However, these numbers are measured in the lab, and there are many variables that reduce the actual amount of protection that most people get when they apply sunscreen in the real world. For instance, most people don’t apply enough (see number 3, below, to learn how much you should be using). Also, sunscreen can rub off on clothing, when you perspire, and of course, when you go in the water.

One popular misconception is that a higher SPF guarantees you’re getting a stronger sunscreen. In fact, SPF only measures protection against UVB (burning) rays. For the best protection, your sunscreen should also protect against UVA (aging) rays, which have been linked to melanoma skin cancers as well as wrinkles and other signs of sun damage.

Another myth is that using a sunscreen with twice the SPF gives you double the amount of sun protection. Actually, a sunscreen with SPF 30 only gives you 4 percent more UVB (burn) protection than one with SPF 15. One study showed that people who reapplied an SPF 15 sunscreen every three hours were less likely to sunburn than those who used an SPF 30 sunscreen and stayed out all day but didn’t reapply.

To make sure you’re adequately protected, you need to:

  1. Choose a sunscreen with an SPF of 15 or higher.
  2. Look for ingredients such as zinc oxide, titanium dioxide, or Mexoryl, which protect against UVA rays. Mexoryl, the newest FDA-approved sunscreen ingredient, can be found in Anthelios SX Daily Moisturizing Sunscreen Cream (available at drugstores) and Lancome UV Expert SPF 20 Sunscreen (sold in department stores). Helioplex, a patented combination of two ingredients that protect against UVA rays, is found in Neutrogena brand sunscreens. My patients with oily or acne-prone skin really like Neutrogena Ultra Sheer Dry-Touch Sunblock SPF 55, which dries invisibly. If you have normal to dry or sun-damaged skin, try Neutrogena Age Shield Sunblock SPF 30, which doubles as a daily moisturizer.
  3. Make sure you apply enough sunscreen. You need a tablespoon to cover your entire face (including ears), and a shot glass–sized amount to cover the exposed areas of your body.
  4. Reapply sunscreen every three to four hours, as well as after bathing or swimming.

Q3. My skin seems to break out more in the summertime. Why is that, and is there anything I can do about it?

— Gia, Texas

Summer heat, sweat, and humidity — combined with makeup and your skin’s natural oils — can clog pores, leading to more breakouts than usual. If you usually use a creamy cleanser, this is a good time to switch to a gel face wash, which will leave your skin cleaner.

As always, be sure to wash your face at night, especially if you’ve been wearing makeup and sunscreen all day. Look for a cleanser that contains salicylic acid, which gets into the oil glands and helps unclog pores. Try L’Oreal Go 360 Clean Deep Facial Cleanser, which comes with a soft “scrublet” to help remove sunscreen, makeup, and dirt.

Warmer weather is also a good time to switch to lighter makeup. For a fresh summer look, try swapping your heavier foundation for a tinted moisturizer, which helps even out your skin tone but won’t look or feel like a mask on a hot, humid day. I like Laura Mercier Tinted Moisturizer SPF 20 and Clinique Moisture Sheer Tint SPF 15.

Summer is also a good time to re-evaluate your sunscreen routine. Some heavy, greasy sunscreens can aggravate breakouts, so try a sheer, lightweight formula like Neutrogena Ultra Sheer Liquid Daily Sunblock SPF 70 or Clarins UV Plus Day Screen High Protection SPF 40, both of which dry invisibly, leaving a matte finish. They’re also both water-resistant, so they’re perfect for active lifestyles and humid climates.

Heat and perspiration can also cause breakouts on your body as well as your face. If you’ve been sweating more than usual and have itchy red bumps on your chest and back, you may have a condition called “miliaria” (also known as “prickly heat”). These bumps are caused by clogged sweat glands, and typically go away on their own after a week or two if you keep your skin cool and dry. In the meantime, try a mild over-the-counter cortisone cream (like Cortaid or Cortizone 10) or a soothing lotion like Caladryl Clear Anti-Itch Lotion to help soothe the itch.

Stay cool this summer!

Q4. I am 67 years old, and because I spent a lot of time in the sun, my skin looks like an orange peel. Is there any vitamin or skin cream I can use to improve my skin? I am not looking for a transformation, just a slight improvement.

— Marilynn, Illinois

First and foremost, you should apply a sunblock, with an SPF of 15 or greater, every day. I believe that the higher the SPF factor, the better. Though most sun damage occurs in our youth, we are still susceptible to skin changes as we age. Clinical studies have shown that the number of precancerous lesions among your age group can be reduced by daily application of sunblock.

Depending on the degree and type of sun damage to your skin, you might want to consult with a dermatologist about possible treatment with 5-fluorouracil cream, which can treat precancerous changes of the skin and, an extra benefit, may result in a rejuvenated facial appearance.

The gold standard of treatment for the reversal of photoaging (aging of the skin due to sun exposure) is the use of vitamin A acid derivatives, such as retinoic acid and adapalene, in prescription preparations such as Retin-A, Renova, Tazorac, and Differin creams and gels and in over-the-counter preparations with retinol. Using these products may help reduce fine wrinkling and pigmentary changes and result in an overall brightening and smoothing of the skin. Glycolic acids have also been shown to improve skin texture and fine wrinkling.

Now, with the advent of antioxidants such as vitamin C, green tea, berry extracts, coenzyme Q, peptides, and growth factors, a new generation of products is available for skin rejuvenation. Products containing these ingredients may be obtained in higher concentrations from your dermatologist. Cosmetics containing lesser concentrations are available in drugstores and department stores — for example, RoC Deep Wrinkle Serum, Oil of Olay Total Effects and Regenerist products, and Eucerin Q10 Anti-Wrinkle Cream.

Learn more in the Everyday Health Skin and Beauty Center.

Unless you’re perpetually living under an umbrella, summertime should be just as synonymous with skin protection as it is with swimsuits. In fact, can we get a motion to rename swimsuit season, sunscreen season? With skin cancer on the rise, lathering on the SPF (on your face, on your body, and yes, even when it’s cloudy) should be step one of your summer beauty routine.

While prevention and protection are your number one focus, being extra vigilant about spotting potential signs and symptoms of skin cancer is just as vital — every single burn or tan you get this season ups your risk. “Getting a sunburn is visual evidence that you’ve gotten enough UV exposure to cause mutations in your DNA that put you at increased risk for skin cancer,” Erin Gilbert, M.D., Ph.D., Vichy consulting dermatologist and celebrity skin expert, tells Allure. The more you get, the higher your risk. “If you get five sunburns, your risk of developing melanoma is approximately doubled. Is a single sunburn bad? Yes, but it’s the overall accumulation of UV damage to your skin that occurs from summer to summer that really puts you at risk.”

According to the experts, here’s what to watch for to make sure your skin stays cancer-free.

1. Shifting spots

“If you have a new or changing brown spot, visit a board-certified dermatologist to get it checked out,” Joshua Zeichner, M.D., director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City tells Allure. “It is normal to develop new brown spots up until the age of 30, however after that time, every new spot should be evaluated.” As a general rule, follow your ABCDE’s. A stands for asymmetry — check for moles that don’t look the same on both sides. B stands for border — spots with jagged edges are no bueno. C stands for color — moles that get crazy colorful (white, black, blue or multicolored) should be checked out. D stands for diameter — anything bigger than the size of a pencil eraser deserves a professional look. E stands for evolution — anything that changes over time could be cause for concern.

2. Painful mole

If a mole suddenly starts giving you other issues such as “a change in the sensation of a mole, like itchiness, tenderness or pain,” that’s worth a look as well, Sejal Shah, M.D., board-certified dermatologist in New York City, tells Allure.

3. Weird bumps

Moles aren’t the only bumps to watch. “If you have a new flesh-colored or pearly bump on the skin, it should be evaluated. It may be a basal cell carcinoma,” says Zeichner. “While these are rare in young patients, it can happen — especially if you were exposed to significant amounts of sun when you were young. According to Gilbert, basal cell cancers can start as flat shiny spots and become bumps over time. “If you notice a new skin-colored or pink bump in a sun exposed area, you should definitely have a dermatologist evaluate it,” she says.

4. Persistent scabs

Scabs or wounds that don’t heal over a couple of weeks could also be an issue. “This may represent a squamous cell carcinoma,” says Zeichner. “Similar to basal cell carcinomas, they are rare, but can develop in younger patients especially if there was a significant history of sunburns.”

5. Scaly skin

This type of skin cancer might also manifest in the form of a scaly or rough patch —”we call this the ‘ugly duckling sign’,” says Shah. “Pre-cancerous lesions called actinic keratoses show up as tiny gritty, scaly spots on a red or pink base that can often be picked off with a fingernail, but then return again in the same location,” adds Gilbert. If not treated, these can turn into squamous cell cancers.

P.S., no skin is safe from regular sun exposure. “It’s important to know that skin cancer most often appears in areas where you are most exposed to the sun, like the face, chest, shoulders, arms, hands and legs. However, this isn’t always the case,” says Gilbert. “Skin cancer can appear on the palms or soles of your feet, beneath your nails, or in your mouth or groin.” Those with darker skin tones aren’t exempt from a strict sunscreen routine either (in fact, those with dark skin might actually have a higher risk of skin cancer).

To protect yourself, always, always, always apply sunscreen and add extra burn protection by staying in the shade or wearing a hat when you can. “The current recommendation from the American Academy of Dermatology is to choose a product with an SPF of at least 30. I personally recommend my patients using the highest SPF possible,” says Zeichner. “While theoretically there is very little difference between a product with SPF 30 and anything higher, starting out with the sunscreen that has a higher SPF is like an insurance policy to make sure that you get the highest quality protection for the longest period of time in the real world.”

Armed with this knowledge, you’re so ready for sunscreen season.

For more skin cancer secrets:

  1. You’ll Think Twice About Tanning After Seeing This Woman’s Graphic Selfies
  2. These Are the Weird Places You Could Get Skin Cancer
  3. The Surprising Place You Should Be Applying Sunscreen But Probably Aren’t

For something so commonplace, freckles can be a contentious topic. A genetic gift from Mother Nature, they’ve been both shunned and embraced by the fashion world, with even-toned complexions long deemed ideal, while freckles – real and faux – are sent down the catwalks in cyclical celebrations of diversity. Currently, thanks to the Duchess of Sussex embracing hers for her wedding day (and beyond), freckles are firmly in favour again. But whether you love them or not, there’s more to know than whether they’re considered ‘on trend’.

Many of us refer to most small, dark marks on the face and body as ‘freckles’, but they’re not all what they seem. Consultant dermatologist Dr Daniel Glass, from The Dermatology Clinic told us that real freckles are most commonly found on younger skin from childhood. “There are three main types of skin pigmentation on the skin, including freckles, however these develop into different skin conditions as we grow older,” he explains. Confused? Here Dr Glass and leading dermatologist Dr Stefanie Williams takes us through the different types of pigmented lesions and marks on your skin so you know what’s what.

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1. Freckles

“A freckle is a small, pale to dark brown flat area of skin with a poorly defined border. They are caused by overproduction of melanin pigment by the melanocytes, which is in direct response to UV light exposure. This response occurs in people with a variant of a particular gene called MC1R,” explains Dr Glass. “Visually, people with this variant have red hair and pale skin, and can burn more easily, and far quicker in the sunshine”.

He adds: “Freckles are most prominent on sun‐exposed areas of the skin during the summer months, and tend to fade during the winter season.”

2. Solar lentigines

As we develop and grow, our ‘freckles’ can change to become solar lentigo; a flat, brown mark, explains Dr Glass. “These skin abrasions tend to accumulate with age as a result of sun exposure and, once they appear on the skin, they will not fade in winter months. They are not cancerous and can occur anywhere on the body, but most commonly on the forearms, back of the hands, shoulders and face. Solar lentigines that appear on the back at a later age have been linked to sunburn in this area in childhood. Sun avoidance, use of a broad spectrum, high factor sunscreen, and appropriate clothing lowers the possibility of new lesions emerging in the future.”

If you’re wondering whether your last sunburn could cause these, Dr Williams explains it’s now possible to tell: “Prior to this type of cumulative damage becoming visible to the naked eye, we can make it visible with a Wood’s light, such as the Visia scan.” Should they concern you, treatment can commence thereafter, though fair skin types will be more likely to show cumulative sun damage even with proper care.

3. Lentigo maligna melanoma

“Both freckles and solar lentigines are harmless and completely benign, but it’s is often difficult to recognise the differences between these marks, and a type of skin cancer called lentigo maligna melanoma,” explains Dr Glass.

“This type of skin cancer also presents as a flat, brown or black, irregularly shaped lesion, but it grows very slowly. It occurs on areas of over-sun exposed skin such as the face, neck and forearms. So if you notice a brown spot with multiple colours or an irregular border, it’s important to seek medical advice as soon as possible, as a biopsy may be required.”

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4. Melasma

“Melasma is more common in people who tan easily or who have a Mediterranean-type olive complexion,” says Dr Williams. “These larger dark patches of pigmentation are sharply demarcated and bizarrely configured. Melasma may appear as mask-like patches on the cheeks, temples, above the upper lip and/or forehead and is also called a ‘pregnancy mask’ as it often occurs with hormonal changes at this time.”

5. Hyperpigmentation in darker skin tones

“Post-inflammatory hyperpigmentation (PIH) is another type of pigmentation that is more common in darker skin phototypes,” says Dr Williams. “These are stubborn brown patches triggered by inflammation in the skin, such as acne, eczema, or trauma. The melanin pigment in PIH may be located in the epidermis, which is easier to treat, or may drop down into the papillary dermis.”

FRECKLED SKIN AND SUN EXPOSURE

The advice for those with freckled skin is to avoid sun bathing and the use of sun beds, and when out in sunny weather to wear a sunscreen with both high factor (SPF50) UVB protection and UVA protection. “You probably only need 10 or 15 minutes of sun on your face and forearms to get enough vitamin D in the summer,” Dr Glass says, though not all experts are in agreement that you should expose your skin to the sun to get vitamin D. “In the winter many people in the UK are vitamin D deficient and a supplement can be useful,” Dr Glass adds.

TREATMENT OPTIONS

Treatment isn’t needed for freckles and solar lentigines as they are totally harmless. However, if you’re unhappy with pigmented lesions on your skin, a dermatologist will be able to advise on a range of visual treatments. Dr Glass explains, “these include chemical peels and cryotherapy (liquid nitrogen freezing) to remove the lesions, laser treatments and lightening creams to reduce the appearance and intense pulsed light treatment, which balances uneven melanin levels.”

If you are concerned about any changing pigmented spots on your skin, you should seek advice from your dermatologist, who will also be able to arrange surgical excision of any lesions that may be of concern.

So, there you have it. We say honour, don’t hide, your freckles – but practice safe sun exposure and don’t hesitate to seek medical advice if they change in appearance. Visit your dermatologist for more advise.

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On the other hand, age spots, which are called lentigines, are often darker in colour and are more defined and usually larger than freckles.

“Lentigines are due to localised proliferation of the cells that produce pigment. The most common type are solar lentigines, which are seen in middle age and are from sun damage. Lentigines tend to persist for long periods and don’t disappear in the winter (though they may fade). They are common in those with fair skin but are also frequently seen in those who tan easily or have naturally dark skin,” Dr Galgut explains.

If you do notice that you have recent spots, that have more than one colour and irregular borders, Dr Galgut recommends that you should have them checked by your doctor to ensure that they are not an early malignant melanoma.

If you’re going out in the sun, how can you prevent getting more freckles and aging marks as you get older? Dr Galgut explains that while not all brown marks can be prevented, sunscreen alone isn’t enough to stop the process of getting more.

“Staying out of the sun and using sun protective clothing is much more effective than sunscreens alone. Sunscreens must have high sun protection factor (SPF 50+), broad spectrum cover against both UVA and UVB rays and should be applied liberally and frequently,” Dr Galgut explains.

And use it. Daily.

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Skin cancer

App to facilitate skin self-examination and early detection. Read more

Text: Miiskin

The first sign of a melanoma is usually an unusual or funny-looking mole or freckle. Look out for:

  • Change in the colour, shape or size of a spot
  • A spot that is itchy, painful or tender
  • One that stands out from other spots – an “ugly duckling”

If you find an “ugly duckling” on your skin, see your doctor right away.

Melanomas stand out from other spots

Superficial spreading melanoma Lentigo maligna melanoma Superficial spreading melanoma Nodular melanoma
  • See more images of superficial spreading melanoma
  • See more images of lentigo maligna melanoma
  • See more images of nodular melanoma

Moles and freckles

Most moles, spots, freckles and bumps on the skin are harmless, but this is not always the case:

  • About 75% of melanoma are new spots that appear in normal skin – a new ugly duckling.
  • Other melanomas start within an existing mole or freckle – watch out for change.

Normal moles

Most people have several normal moles on their skin and a few people have lots of them. These ‘normal moles&rshquo; are also called melanocytic naevi because they are made up of melanocyte cells. Normal moles may be flat or raised and vary in colour from pink to brown or black. The colour depends on how much pigment or melanin is made by the melanocytes. They are mostly round or oval shaped but can sometimes be odd shaped. They can be tiny spots or up to several centimetres in size.

Normal moles are harmless but in some cases a melanoma may start from within them. People with lots of moles, especially those with over 100 moles, are at greater risk of getting melanoma than those with few moles. If you start to notice any changes in a mole, it’s best to get it checked out by a doctor.

Funny-looking moles

Funny-looking moles are also called atypical naevi or dysplastic naevi. These moles are basically normal moles with some unusual features such as large size or an odd shape with blurred edges or a flat and bumpy surface. Funny-looking moles may look like melanoma but are actually harmless (benign) spots that don’t need to be removed. However, if you have a few, particularly five or more of these funny-looking moles, your chance of getting a melanoma is increased. If you are unsure about any of your funny-looking moles it’s best to get them checked out.

Brown spots and freckles

Freckles are small flat brown marks that most often appear on the face and other exposed parts of the body in the summer months. They are most often seen in fair-skinned people with red hair but can be seen in people with darker skin colour too. Freckles are formed when the skin is exposed to the sun. Freckles are harmless, but if one starts to look funny compared to others then it’s best to get it checked out.

Larger, flat, brown spots on the face and hands that start to appear in middle-aged people, known as age spots or liver spots, are properly called solar lentigines. These occur in people of all skin types if they have spent too much time exposed to the sun. Solar lentigines are harmless too but because they can sometimes turn into melanoma it is good to get them checked out, especially if they start to change colour or shape.

Seborrhoeic keratoses

Seborrhoeic keratoses grow in number as we get older. Most people over 40 have at least one of these warty spots, and some people have hundreds. They are stuck on to the skin rather like barnacles and can be clustered around the neck or under the breasts, or scattered all over the body. They can be any colour including white, yellow, brown and black. Seborrhoeic keratoses can be irritating, but are actually harmless. If in doubt – check it out!

These are different kinds of moles and freckles

Normal moles Atypical naevi Solar lentigines Seborrhoeic keratoses
  • See more images of atypical naevi
  • See more images of solar lentigines
  • See more images of seborrhoeic keratoses

Other types of skin cancer

When looking for the ‘ugly duckling’ spot, you may discover a actinic keratosis or another type of skin cancer such as basal cell carcinoma or squamous cell carcinoma. Look out for:

  • A growing spot that is rough, dry or scaly
  • A spot that has become a thickened and raised bump
  • A spot or sore that bleeds easily or is crusted over
  • A sore that doesn’t heal

See your doctor to confirm the diagnosis and find out treatment options.

These are non-melanoma skin cancers

Actinic keratosis Basal cell carcinoma Basal cell carcinoma Squamous cell carcinoma

  • See more images of actinic keratosis
  • See more images of basal cell carcinoma
  • See more images of squamous cell carcinoma

On this page:

  • The Deadly E Change
  • How Much Time Do You Have to Act?

Finding Melanoma Early: Warning Signs & Photos

In most cases, melanoma is easy to self-detect at an early stage while it is curable by simple surgical excision. Although the visual appearance of a skin lesion (a growth or mark) is often an indication of melanoma, you cannot always rely on this alone. You should also be aware of the history of your skin lesions—any changes that occur in them, as well the onset of any new ones. The only way to develop this awareness is by regular self-examination of your skin. We recommend a complete self-skin exam once every month.

WARNING SIGNS OF MELANOMA
Any of these should prompt an immediate visit to a dermatologist or plastic surgeon:
Any change in a mole, blemish, freckle, birthmark, or pigmented area
A new mole or freckle that appears out of the blue or is growing rapidly, especially if you don’t have many moles, or the new mole or freckle looks different from those you do have
A mole or other growth that has any of the ABCD properties or all of the EFG properties
A change in surface texture or in the way a mole feels to the touch
A new “freckle” that is dark, dry, or scaly
A pigmented area or splotch that is new or that you don’t remember seeing before
A new spot that is black, even if very small
A mole or other spot that looks or behaves differently than those around it, even if it seems otherwise normal
A mole or other spot that itches and/or bleeds
Redness, other color, or shadow extending into the surrounding skin

There are two types of melanoma: radial and nodular. Radial melanomas are easier to self-detect because they grow in diameter near the skin surface before growing downward through the skin. Radial melanomas usually have two or more of the ABCD properties, as shown below.

Please note these photos show only a few of many different ways melanomas may appear; read this entire page to learn about other possible warning signs.

ABCD Properties of Radial Melanomas

A = ASYMMETRY B = BORDER
Radial melanomas are often unsymmetrical; an imaginary line through the middle does not
produce matching halves. (Dermnet.com)
The borders of radial melanomas may be uneven, fuzzy, or have notched or scalloped edges. (Dermnet.com)

C = COLOR D = DIAMETER
Radial melanomas often begin to show color changes in areas, with shades of black, brown, tan, and sometimes other colors. (Dermnet.com) Unlike normal or atypical moles, radial melanomas often grow larger than the width of a pencil eraser. (Dermnet.com)

SIMULATED PROGRESSION OF AN ATYPICAL MOLE TO RADIAL MELANOMA

In the animation above, the earliest signs of an atypical mole changing into a radial melanoma are 1) the increase in size, and 2) the shape becoming more irregular. This is the time to act. As the melanoma continues to grow, its color becomes darker and less uniform, black bumps begin to appear, and in the late stages, most of the melanoma has become black and lumpy. The initial appearance of bumps often signals the last chance to act before a melanoma spreads internally.

This represents just one of many different ways a mole can change. Usually these changes occur over a period of several weeks, or more typically, months. Although not all changes will turn out to be melanoma, don’t take any chances, and above all, don’t make the mistake of trying to be your own doctor.

The Deadly E Change

In addition to the ABCD properties, there is an E change to watch for, and if you see it you should act immediately. E equals elevation. The beginning of a bump or thickness increase in a mole, freckle, blemish, or birthmark—even if the increase is small—often signifies a melanoma that is entering a dangerous phase. Elevation changes are critical because, when the thickness of a melanoma exceeds 1 mm, the chance of internal spread increases. When the thickness reaches 3 mm, curability is only about 50 percent and quickly decreases as the thickness increases further.

The animation above shows a radial melanoma growing into the skin. Radial melanomas start in the thin outer layer of the skin (the epidermis) and at first usually undergo a surface growth phase that is noninvasive and completely curable. As the melanoma grows and reaches the middle layer of the skin (the dermis), it begins an “invasive radial” growth phase. Still, curability is about 90 percent at this point. As it penetrates further into the dermis, however, it begins an “invasive vertical” growth phase, becoming less curable as downward growth progresses into the loose connective tissue beneath the dermis (the subcutaneous layer). Malignant cells may be released into lymph and blood vessels, spreading to other parts of the body.

In short, a lump or elevation increase above the surface of the skin is a warning sign of vertical growth beneath the surface.

This elevated melanoma started in a mole that grew darker and larger, then developed a bump on the left side. At this stage, it was destined to be fatal. If it had been removed while it was flat, or even when the bump first started developing, it likely would have been curable. (National Cancer Institute)

EFG Properties of Nodular Melanomas

About 20 percent of melanomas begin the dangerous vertical growth phase with little or no radial growth first. For these nodular melanomas the ABCD properties do not apply; instead they have three combined EFG properties.

E = ELEVATED Early elevation above the skin surface
F = FIRM Firm to the touch, not flabby
G = GROWING Continues growing more than two to three weeks

Any of the following warning signs may indicate a nodular melanoma:

  • The start of a new bump in a mole, freckle, blemish, or birthmark.
  • The start of a thickness increase in a previously flat or slightly raised mole.
  • In otherwise clear skin, the beginning of a bump that looks like a blood blister, bubble, or pimple that continues to grow after two to three weeks, especially if you don’t ordinarily have pimples and haven’t injured yourself at the site of the blood blister.

Although a nodular melanoma can arise in a pre-existing mole, it is more common for one to develop spontaneously from normal skin, as in the four photos above. All of these were fatal. The colors of nodular melanomas are usually black, blue-black, dark brown, or brown-red. However, occasionally they are red (third photo from left), pink, grey, flesh-tone, or light to medium brown (far right photo, from the ankle of a 12-year-old boy). Nodular melanomas are typically dome-shaped and lacking in the ABCD properties, making visual diagnosis more difficult than with radial melanomas.

SIMULATED DEVELOPMENT OF NODULAR MELANOMA ON CLEAR SKIN

How Much Time Do You Have to Act?

  • Nodular melanomas can spread internally in as little as three months.
  • Most radial melanomas can spread internally within 6 to 18 months from the first noticeable change of a pre-existing mole or appearance of a new mole.
  • Radial melanomas that develop from age or liver spots (which typically occur in people 70 or older) can take as long as 10 to 15 years to spread internally.

Page 4

Reduce your risk

Most skin cancers are caused by too much sun. You shouldn’t avoid the sun completely, as it is an important source of vitamin D.

However, to reduce the risk of skin cancer, avoid sunburn by:

  • spending time in the shade when the sun is at its strongest, usually between 11am and 3pm, from March to October
  • covering up with clothes that protect you from the sun
  • wearing sunscreen with a sun protection factor (SPF) of at least 15 and a high star rating

Even if it is cool or cloudy, you could burn in the middle of the day in summer. It’s also possible to burn at other times of the day and year.

Take extra care when in sunnier climates – you may burn quickly, even when it isn’t hot.

Sunbeds and sunlamps can increase your risk of developing skin cancer. Public Health England recommends that you don’t use them, except for medical reasons.

Other ways to reduce your risk

A healthy lifestyle can help you reduce your risk of skin cancer. Some ways to stay healthy are:

  • stop smoking – if you smoke, the best thing you can do for your health is to quit. There’s plenty of support available from the NHS. Visit nhs.uk/smokefree or call 0300 123 1044.
  • look after yourself – try to maintain a healthy weight and keep active. Swimming, cycling, dancing, walking – the more you can do, the better. Try to eat a healthy, balanced diet too, with plenty of fruit and vegetables.
  • cut down on alcohol – drinking too much alcohol can lead to a number of health problems. By drinking less, you’ll reduce your health risks.

For more information on how to reduce your risk of cancer, visit nhs.uk/reduce-your-risk.

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