Melanoma or Age Spots? How to Tell the Difference

Some changes in your skin come with age, such as the unpopular age spots (also known as sun spots or liver spots). These have nothing to do with the liver and are caused instead by long-term sun exposure. Some of these dark spots, however, may look suspiciously like melanoma, the most deadly form of skin cancer. If you're not a dermatologist, you might be staring at the new brown mark on your skin and wondering whether it's merely a cosmetic issue or something worse.

As a general rule, if that spot you're staring at is new to you, it's a good idea to check in with your dermatologist, says John Wolf Jr., MD, a dermatologist, professor and chairman of the dermatology department at the Baylor College of Medicine in Houston. "I strongly recommend a full-body exam for anyone over age 50 - maybe even earlier for some patients," he says. People who have a personal or family history of skin cancer should go for an exam sooner.

What appear to be new age spots or liver spots could be a good excuse to get this process started. Even if your dermatologist finds no sign of skin cancer, he or she can let you know whether you have skin issues to watch out for. This doesn't just apply to fair-skinned people either: Dark-skinned individuals can also get skin cancer - and sometimes it's harder to see the early signs of it without professional help.

If you have an age spot, it will probably fall into one of three categories:

• Cherry hemangiomas. Small red dots that are smaller than a pencil eraser, these are caused by an overgrowth of blood vessels in the skin. They are common and can appear anywhere, but they are not linked to skin cancer.
• Lentigines. These are flat, tan-to-dark spots that look similar to freckles. They usually range from the size of a pencil eraser to the size of a dime, but they could be bigger or smaller. These are what most people typically think of as age spots or liver spots. They are usually located on sun-exposed areas of the skin.
• Seborrheic keratoses. These can be flat or raised and range from pale to dark brown or black. They are often scaly or wart-like, although they are not warts. "They can be due to sunlight, age, and are also genetic," says Dr. Wolf. People who have many of these skin changes have probably seen them before on a first-degree relative. They are also linked to skin tags, another kind of benign skin growth.

Melanoma in its early stages can resemble lentigines or, sometimes, seborrheic keratoses. "If a melanoma arises in a pre-existing mole, it is raised and smooth," says Wolf. "If it arises on normal skin, it starts as a flat brown to black growth, then grows out or down."

If a bump grows on a mole or in a previously flat, discolored spot, see your dermatologist right away to get checked for possible skin cancer.

One reason to call your dermatologist immediately is that if melanoma is diagnosed early, "it can be cured with surgery," says Wolf. But once it starts to deepen or spread to other parts of your body, melanoma can be difficult to treat.

If you see a suspicious spot on your skin, run through the ABCs of melanoma, says Wolf. They are:

• Asymmetry means that the growth is different on one side than on the other. One side is typically bigger.
• Look at the border. "If it is irregular, that's a suspicious sign," says Wolf.
• The color of the lesion (or growth) is also telling. Lesions with more than one color are suspicious. The darker the lesion, the greater your concern should be.
• Melanomas tend to be larger in diameter than a pencil eraser. Wolf warns that this guideline isn't completely reliable, however - melanomas can be very small and still be problematic.
• Consider the evolution (or change) of your skin spot. Sudden changes, bleeding, itching, and pain all require a doctor's appointment for further diagnosis.

When your doctor is concerned about a particular spot, he or she might remove part or all of it and send it off for a biopsy.

If you simply have age spots, as is the case most often, you have several options if they bother you for cosmetic reasons. A dermatologist can remove or lighten the spots (although insurance might not cover this procedure). Your doctor might recommend freezing the spot, using a chemical peel, or trying a laser treatment. You can also help prevent new ones by using sunscreen regularly.