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Dark Spots On Your Skin – Are They Dangerous?

Dr. Barry Lycka - April 12, 2016

Dark spots on your skin, and other dark, discolored patches, take many forms. Some are harmless, but some can be deadly – but how can you tell?

When should you be worried? What help and treatment is available?

We have some excellent answers for you this week when Dr Barry Lycka talks with Board Certified Dermatologist Dr Neelam Vashi. She is an Assistant Professor of Dermatology at Boston University School of Medicine, and is the Founder & Director, of the Center for Ethnic Skin.

Dr Lycka & Dr Vashi talk about the different types of dark spots on your skin, as well as moles, lesions and dark patches that also appear on our skin. They help you identify if a mole should be checked out by explaining the ABCDE of skin cancer checks. These checks can highlight if a mole or dark spot, is possibly a melanoma skin cancer.

Of course there are other spots and moles that are not cause for concern. The two Dermatologists describe what are seborrheic keratosis, freckles and lentigines, and what can be done to make them look better.

Dr Vashi highlights two other problems – melasma & post inflammatory hyperpigmentation. She talks through what they are, what they look like, what causes them and different treatments for them.

So today’s main message is – Don’t ignore these spots and patches, but don’t worry too much either. Listen to this interview to learn more, and then go and see an expert dermatologist like Dr Lycka or Dr Vashi to seek their experienced opinion.



Or continue reading for the summarized highlights…

When does a dark spot cause concern?

Of course, a skin cancer can also be pale in color. But when we are looking at something that is worrisome, we use the ABCDE ‘rules’ to help us.

If you see a dark spot on your skin that is

  • ASYMETRICAL (that is the A)
  • Irregular BORDERS (B)
  • Different COLORS (C)
  • Big DIAMETER (D)
  • EVOLVING / changing (E)

Then that is something to be more concerned with.

Any other tell-tale signs of melanoma?

As well as the ABCDE’s, a spot that is problematic, such as bleeding, or itchy, that would also be of concern.

Going through the ABCDE’s in more detail…

IF a spot is not symmetrical, that is more concerning. Asymmetry is when one side of a mole doesn’t look like the other side, and it is growing a bit out of synch. Most moles that are benign are pretty symmetrical – not completely.

IF a spot has irregular borders, and jagged edges then we get more worried about it – that jaggedness is a sign that there is some sort of growth going on.

IF a spot has color variation, has many different colors in it, or even shades of brown, that is more concerning because that means that there is some sort of growth going on that isn’t completely normal.

IF a spot has a size that is bigger than the end of a pencil, that is more concerning, but it is not the only sign because lots of things are bigger than that without having a major concern

And the last if it is changing over time, evolving, then again, that is more concerning. We need to be thinking about it and taking notice. If a mole doesn’t look the same as it did a month ago vs a year ago then something is going on

Sadly, there are more and more cases of Melanoma, and yet it is a type of cancer that is diagnosable and treatable – if we catch them early we can do a lot with them, and have the best chance of curing them.

Any spots you SHOULDN’T Worry About?

Since we have been talking about melanoma, its worth saying that the biggest lesion that patients are concerned about that fits a lot of those criteria are these non-dangerous growths called seborrheic keratosis. They often occur on the face, and also on the back and chest, underneath the breast. These are non-dangerous growths of the top layers of the skin and they can have different colors, look bigger, and can even be picked off sometimes and bleed, which lead them to look like the disturbing signs from melanoma, but they are actually non-dangerous lesions.

For qualified doctors such as Dr Vashi & Dr Lycka, they are not a major concern, and usually they can be spotted a mile off. The good news is that Dr Lycka loves seeing patients when they have these because firstly he can reassure them that they are not going to die, and secondly that they are a sign that they are getting more mature and their skin is getting a bit older, so they are really ‘wisdom spots’ rather than anything else, and they have earned the right to have them!

What about Freckles – what does that mean? And What Are Lentigines?

Well freckles are non-dangerous spots on the skin as well. They are very common in our lighter skinned patients. Older patients will get similar spots called lentigines. When we are comparing these flat brown spots on the face, freckles usually occur on the top of the cheek, they are small 1 – 3 mm and they fade over time, especially with using sun protection. There is some genetic cause but also an indication that there has been sun exposure. They don’t have any propensity to undergo any malignant changes.  Lentigines are in a similar family to the freckles and we see those in our older population and they are bigger than freckles 3mm to 2cm in size. They increase with advancing age and for the most part they are non-dangerous, BUT in our older population (in 70s) some of these can become malignant and then the ABCDE’s criteria can be used. There is also another spot in this ‘family’ called dermatosis papulosa nigra and that occurs more in our African American and Afro Caribbean patients. They are essentially smaller and darker seborrheic keratosis.

Can these dark spots be made to look better?

Yes, special lasers work well, especially on lighter skinned people where there is less chance of side effects. It usually takes a couple of sessions to remove these types of lesions. Dr Vashi likes to use the Q-switched lasers, which pulse energy in a very short time. Side effects and problems are seen when a proper q-switched laser has not been used on certain types of skin tones. The wavelength range from low to high – when we are taking off spots in darker skinned patients we should use a higher wavelength because it penetrates deeper into the skin and then protects the top of the skin.

Not all lasers are the same!

Dr Lycka has seen some terrible scars caused by other doctors not using the correct laser for a procedure. The right type and amount of laser has to be used to get the right results. A laser interacts with the skin – it isn’t just magic that makes a lesion vanish! It has to interact with the components of the skin. Each laser has particular things that are very important to a doctor that knows how to use it. These criteria are very important when choosing a doctor who you want to remove these spots for you. If they are using the wrong laser there will be scarring, and that is not what we want.

Another machine that doctors use is an IPL (intense pulsed light) or BBL (broad band light) which are also wavelengths of light that when used properly with the proper cooling can also do some good things for the skin.

Post Inflammatory Hyperpigmentation & Melasma

There is another set of lesions that are more diffuse – they are certainly of concern in people of color – and this is called post-inflammatory hyperpigmentation. There is also Melasma. These 2 lesions are quite different, they act in different ways, and yet many people don’t know how to treat these problems and many people are frustrated because they have been trying to treat these lesions and all they are doing is making them worse!

Post-inflammatory hyperpigmentation and melisma are the top 2 reasons for consultations for Dr Vashi.

Melasma has another term for it – the mask of pregnancy, because it is associated with pregnancy and women’s hormonal therapies and about 90% of cases are in women. What we see in the skin are these patches of hyperpigmentation (darker areas) generally in the central face, middle of the forehead and the cheeks.

These lesions often make people of color very anxious. They like to have uniform colored skin so when there are differences in color it becomes a problem.

Have you found treatments that work?

Yes. The first thing that Dr Vashi always counsels is good sun protection, even in the winter months as sun exposure does make these lesions worse. Then her first ‘go to’ will be topical treatments and the gold standard is hydroquinone. It is essentially a bleaching agent, that comes in different percentages. It can’t be used for an extended period of time. There are also other agents that Dr Vashi uses.

Combination topical treatments that are successful include an agent to help the products get into the skin to act on the pigment cells (the melanocytes).  Dr Vashi uses triple combination creams for example combining a bleaching agent (hydroquinone) with a retinoid (which also in of itself helps with treating darkened patches) but it helps with penetration into the skin. And then also combined with a topical steroid to decrease any inflammation or irritation that those other products can cause.

It is not just one treatment. Things do have to be used in combination. The biggest disappointment is that some doctors over-use lasers to treat these conditions. They do help sometimes but in many cases it can make things worse. Lasers should not be the first line of treatment for anything like this.

Exactly – so the first line treatment for Dr Vashi is topical treatments. Then the second is a lot of chemical peels, and they work very well for patients. Nothing is 100% of course but Dr Vashi finds that adding chemical peels to topical treatments works quite well. They have to be done gently, in a series, in a way that doesn’t cause irritation or inflammation because that will cause the skin to get worse.

Key Messages On These Treatments

So the key message for people who do have these conditions is that they have to be prepared to go through treatments over a longer period of time. It includes prevention, active treatments and it also means home care programs too. Without all these interventions, the chances of success are very small. Tinted makeup can also help mask these lesions.

Dr Vashi does advocate on the oral contraceptives, birth control options, advocating a low estrogen oral contraceptive, or alternatively a copper IUD which doesn’t have hormones in it. Once people are aware of their options, it really helps with controlling these problems.

And Dr Lycka would also like to warn people to not just use everything over the counter. Being your own doctor is not the best thing in a situation like this. There are a lot of issues in treating yourself with these pigmentary agents that you will not be aware of, and you can actually make your situation and problems even worse.

Yes, that is very true – including the most dreaded side effects of hydroquinone which is exogenous ochronosis. Although we don’t know exactly what is happening when this occurs, it has mostly been associated with high concentration of hydroquinone being used for extended amounts of time. Sometimes products are adulterated with other components like resorcinol which is another form of skin lightening agent. But when this happens there are dark spots which occur within the existing dark spots and it is incredibly hard to treat once that side effect has happened.

Dr Lycka knows that once that starts it is very hard to reverse. In fact, Dr Lycka doesn’t know of a great treatment for ochronosis once it is fully established. Dr Vashi actually has several patients with it and all have been caused by using products from overseas. So they have not been using US products under the care of a physician. It is incredibly hard to treat. We have to use some of the very, very short lasers (the pico second lasers) as they can break up the pigment a bit.


Contact details for Dr Neelam Vashi & Dr Barry Lycka:

Dr Neelam Vashi

               Affiliated with Boston University Cosmetic Center

Telephone: (617) 414 2676

Website:     http://www.bmc.org/bu-cosmetic-laser-center.htm

Email:        cosmetic.clinic@bmc.org



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