- Macular a flat, demarcated area of increased skin pigmentation which is neither raised nor depressed
- Usually brown, black, or gray
- Found on skin that has had the most sun exposure over years, usually on the backs of hands, tops of feet, face, shoulders and upper back
- Variable in size, from 1 millimeter to 3 centimeters across
- Prone to group together, making them more prominent
- Sometimes similar in appearance to malignant or nonmalignant lesions
- More likely to occur in white or Asian people, especially in persons with a tendency to freckle
Melasma and ephelides are two types of nonmalignant, macular, hyperpigmented lesions which can be mistaken for age spots. Melasma is a progressive, nonscaling hyperpigmentation of sun-exposed skin, especially on the face and forearms. The formation of melasma is often associated with pregnancy, oral contraceptives and some anticonvulsants. It may appear spontaneously with no identifiable cause or association to known co-existing factors. It occurs in women nine times more frequently than in men, and more often in skin types common to Asia, the Middle East and South America. It is of no consequence to health, but may be distressing cosmetically.
The face is the most common site of melasma, usually in the center of the face; less often it occurs around the mouth and jaw. The patches are usually bilateral. There are three types of melasma: epidermal, dermal, and mixed. Epidermal melasma is usually light brown, and enhances under Wood lamp examination. Dermal melasma is grayish and does not enhance with Wood lamp examination. Mixed lesions are dark brown with variable response to Wood lamp. Ephelides is the medical name for freckles, usually 1-2 millimeters, sharply defined, on the face, neck, chest and arms.
Solar lentigines may resemble moles (nevi), which are raised or flat, and are not limited to sun-exposed parts of the body. Seborrheic keratoses, which are nonmalignant, are small, tan, brown or black, with a pasted on appearance. Theres a broad range of normal size, from 1 millimeter to more than 2.5 centimeters. Lentigo maligna is a type of skin cancer, a melanoma, which can develop in areas of long-term sun exposure. It starts as tan to brown to black, that darkens and enlarges. They have irregular borders and are multipigmented within the same lesion. Pigmented actinic keratoses are premalignant.
It is recommended that new skin lesions should be seen by a physician, especially with:
- Dark pigmentation
- Rapid growth
- Irregular borders
- Multiple colors within the same lesion
- Tenderness or bleeding
- Itchy, reddened skin
- Poor healing
Usually a patient is seen by a family doctor first, who may refer a dermatologist. Any lesion which is atypical or suggestive of melanoma should be biopsied, through all layers of the skin. A biopsy may be an excisional biopsy, which removes the entire lesion, or by punch biopsy for large lesions or those in cosmetically sensitive areas, such as on the face. Seborrheic dermatoses and pigmented actinic keratoses can be distinguished by visualization alone. If there is uncertainty about a diagnosis, biopsy should be performed.
Some systemic disorders show first as multiple lentigines: Peutz-Jeghers syndrome, LEOPARD syndrome, and Lamb syndrome.
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