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Age spots on the shoulder and back

Age spots — also called liver spots and solar lentigines — are flat, gray, brown or black spots. They vary in size and usually appear on the face, hands, shoulders and arms — areas most exposed to the sun. Though age spots are very common in adults older than age 40, they can affect younger people as well.

True age spots are harmless and don't need treatment, but they can look like cancerous growths. For cosmetic reasons, age spots can be lightened with skin-bleaching products or removed. However, preventing age spots — by avoiding the sun and using sunscreen — may be the easiest way to maintain your skin's youthful appearance and to avoid these dark skin spots.

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Age spots on the shoulder and back

Age spots typically develop in people with a fair complexion but can be seen even in those with darker skin. Age spots:

• Are flat, oval areas of increased pigmentation
• Are usually brown, black or gray
• Occur on skin that has had the most sun exposure over the years, such as the backs of hands, tops of feet, face, shoulders and upper back

Age spots range from freckle-size to more than a centimeter across and can group together, making them more prominent.

Other signs of sun damage
Often, age spots are accompanied by other signs of sun damage, including:

• Deep wrinkles
• Dry, rough skin
• Fine red veins on your cheeks, nose and ears
• Thinner, more translucent-looking skin

When to see a doctor
You may not like the way they look, but age spots are usually harmless and don't require medical care. However, your doctor should evaluate spots that are dark or have changed appearance because these can be signs of melanoma, a serious form of skin cancer.

It's best to have any new skin changes evaluated by a doctor, especially if a spot or lesion:

• Is darkly pigmented
• Is rapidly increasing in size
• Has an irregular border
• Has an unusual combination of colors

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Layers of your skin

Ultraviolet (UV) light accelerates the production of melanin. Melanin is the dark pigment in the epidermis that gives your skin its normal color. The extra melanin — produced to protect the deeper layers of your skin — creates the darker color of a tan. Age spots develop when the extra melanin becomes "clumped" or is produced in higher concentrations than normal.

Most often, it takes years of sun exposure for these dark spots to occur — they typically develop very slowly over time. Using commercial tanning lamps and tanning beds can eventually result in the same changes.

In addition to sun exposure, simply growing older can cause the extra production of melanin and subsequent age spots. Genetics also plays a role in how susceptible you are to the development of age spots.

Although anyone can develop age spots, you may be more likely to develop the condition if you:

• Have light-colored or fair skin
• Have a history of frequent or intense sun exposure or sunburn

You're likely to start by first seeing your family doctor or primary care doctor. However, in some cases when you call to set up an appointment, you may be referred to a specialist in skin diseases (dermatologist).

Because appointments can be brief and there's often a lot of ground to cover, it can help to be well prepared. Here are some tips to help you get ready for your appointment and what to expect from your doctor.

What you can do
Write down questions that you want to ask your doctor. Don't be afraid to ask questions or to speak up when you don't understand something your doctor says. If you have age spots, questions you may want to ask include:

• Are tests needed to confirm the diagnosis?
• What is the best course of action?
• What are my treatment options and the pros and cons for each?
• What will the treatments cost? Does medical insurance cover these costs?
• What results can I expect?
• What kind of follow-up, if any, should I expect?
• What suspicious changes in my skin should I look for?

What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:

• When did you first notice the condition?
• Have you noticed any changes in the appearance of your skin?
• Is the condition bothersome?
• Have you experienced frequent or severe sunburns?
• How often are you exposed to sun or UV radiation?
• Do you regularly protect your skin from UV radiation?

Diagnosing age spots may include:

• Visual inspection. Your doctor can diagnose age spots by visually inspecting your skin.
• Skin biopsy. If there's any doubt, your doctor may do other tests, such as a skin biopsy. During a skin biopsy, your doctor takes a small sample of your skin (biopsy) for microscopic analysis. A skin biopsy is usually done in a doctor's office using a local anesthetic.

Other conditions
Other conditions that can look similar to age spots include:

• Moles. Although they often appear as small, dark brown spots, moles (nevi) vary in color and size. They can be raised or flat and can develop almost anywhere on your body — even between your fingers and toes.
• Seborrheic keratoses. These tan, brown or black growths have a wart-like or waxy, pasted-on appearance and range in size from very small to more than 1 inch (2.5 centimeters) across.
• Lentigo maligna. One type of skin cancer known as lentigo maligna melanoma can develop in areas of long-term sun exposure. Lentigo maligna starts as tan, brown or black lesions that slowly darken and enlarge. They tend to have an irregular border and uneven coloring and may be slightly raised.

If you're unhappy with the appearance of age spots, treatments are available to lighten or remove them. Since the pigment is located at the base of the epidermis — the topmost layer of skin — any treatments meant to lighten the age spots will need to penetrate through this layer of skin.

Age spot treatments include:

• Medications. Prescription bleaching creams (hydroquinone) used alone or with retinoids (tretinoin) and a mild steroid may gradually fade the spots over several months. Sun protection is strongly advised if you use medication treatments.
• Laser therapy. Laser therapy destroys the extra melanocytes that create the dark pigment without damaging the skin's surface. Treatments with a laser typically require several sessions. After treatment, age spots fade gradually over several weeks or months. Laser therapy has few side effects, but it can be expensive.
• Freezing (cryotherapy). This procedure involves applying liquid nitrogen or another freezing agent to the age spots to destroy the extra pigment. As the area heals, the skin appears lighter. Freezing is typically used on a single or small grouping of age spots. Though effective, this procedure poses a slight risk of permanent scarring or discoloration.
• Dermabrasion. This procedure consists of sanding down (planing) the surface layer of your skin with a rapidly rotating brush. This procedure removes the skin surface, and a new layer of skin grows in its place. Redness and temporary scab formation can result from this age spot treatment.
• Chemical peel. Superficial and medium-depth chemical peels can fade age spots. With superficial chemical peels, several treatments are necessary before you notice any results. A chemical peel involves applying an acid, which burns the outer layer of your skin, to the age spots. As your skin peels, new skin forms to take its place. Sun protection is strongly advised following this treatment.

Because age spot treatments are considered cosmetic, your insurance may not pay for it. In addition, any of the procedures can have side effects, so discuss them in advance with your doctor. Make sure your dermatologist is specially trained and experienced in the technique you're considering.

Many fade creams and lotions are available in department stores, in drugstores and on the Internet to lighten age spots and other skin discoloration. These may be good options depending on the darkness of the age spot and how often you apply the cream. Successful treatment needs to penetrate through the base of the epidermis — the topmost layer of skin — where the extra pigment is located. This means regular use over several weeks or months may be necessary before any noticeable results occur.

If you do opt for an over-the-counter (nonprescription) fade cream, choose one that contains hydroquinone, deoxyarbutin, glycolic acid or kojic acid. Note that some products, especially those that contain hydroquinone, may cause skin irritation after prolonged use.

To help avoid age spots, minimize your sun exposure. If you must be in the sun, use a sunscreen with a sun protection factor (SPF) of at least 15. It should be a broad-spectrum sunscreen, which means it blocks both ultraviolet A (UVA) and ultraviolet B (UVB) rays.

• Avoid the sun during high-intensity hours. The sun's rays are most damaging from 10 a.m. to 4 p.m. Reduce the time you spend outdoors during these hours.
• Wear protective clothing. Cover your skin with clothing, such as long-sleeved shirts, long pants and wide-brimmed hats. Also, keep in mind that certain clothing styles and fabrics offer better protection from the sun than do others. For example, tightly woven fabrics are better than loosely woven fabrics.
• Use sunscreen. Apply sunscreen liberally 30 minutes before going outdoors so that your skin has time to absorb the sunscreen. Then reapply according to the directions on the label — usually about every hour.