Sun spots are flat brown patches that build up on the skin the sun reaches most, such as the face, the backs of the hands and the chest. They are harmless, but they are a record of past sun exposure. An actinic keratosis is a rough, scaly patch caused by years of sun. It is a precancer, meaning it is the step before skin cancer rather than cancer itself. Most never progress, but most squamous cell carcinomas start as one, which is why they are treated.
The same eight facts on every condition comparison.
It is a flat area of pigment.
A solar lentigo is a defined patch of increased pigmentation linked to ultraviolet exposure.
It appears on sun-exposed skin.
Spots often develop on the face, hands, forearms and shoulders.
"Liver spot" is a misnomer.
The common name does not mean the liver is involved.
Diagnosis comes first.
Atypical spots can resemble melanoma in situ, so uncertain lesions are examined before any cosmetic treatment.
It is ultraviolet damage.
Actinic keratoses are rough, scaly areas caused by UV damage to skin cells.
It appears on sun-exposed skin.
They occur most often on repeatedly exposed areas.
It is precancerous.
Some can progress to squamous cell carcinoma.
Some lesions need a biopsy.
Thick, painful, ulcerated or enlarging spots are checked for invasive cancer.
Flat brown spots Even tan to brown color.
Backs of the hands One of the most common sites.
Shoulders Clusters after years of sun.
Classic actinic keratosis Rough pink or red scaly spot.
Hypertrophic actinic keratosis Thick, raised and crusted.
Actinic cheilitis Rough, dry patches on the lower lip.
Pigmented actinic keratosis Brown and flat.
Repeated ultraviolet exposure changes pigment activity in a small area of skin. Extra melanin produces a persistent flat brown spot, rather than a raised growth.
Repeated ultraviolet exposure damages the DNA of surface skin cells, allowing abnormal cells to grow within the epidermis. A rough, scaly patch develops, and some lesions can progress to skin cancer.
Sun Spots. Usually become more noticeable in adult life after cumulative sun exposure.
Actinic Keratosis. Usually develops in adults after years of ultraviolet exposure, especially with fair or immunosuppressed skin.
Sun spots form when years of ultraviolet light make pigment cells produce extra melanin in one place. They build up slowly over decades.
Actinic keratoses are caused by years of ultraviolet light damaging skin cells. They are a warning sign of sun damage.
Fair skin that burns easily and a family history of sun spots make them more likely.
Fair skin that burns easily is inherited and is the biggest risk.
Evidence labels come from each condition’s own treatment list.
Speeds up how quickly pigmented surface cells are shed, so spots lighten gradually from the top down. It is the over-the-counter option with the best evidence in sun spots, and it improves the surrounding sun-damaged skin at the same time. Start two or three nights a week to avoid irritation, and expect three to six months before the difference is obvious.
Loosens the pigmented cells at the surface so they shed sooner, which lifts a little color out of a spot over months. It works better as the thing that helps a lightening cream get in than as a treatment on its own. Used too often it leaves skin irritated and more sun-sensitive, which on this page is exactly the wrong direction.
Applied to dry skin, left for about fifteen minutes and washed off rather than left on overnight. It suits people who want a lightening step without hydroquinone, or something to hold a result between courses of it. Most of the trial evidence is in melasma rather than sun spots, and the smell is the usual reason people stop.
A gentler relative of hydroquinone that releases a small amount of it slowly in the skin. It is a reasonable long-term option on a spot you are lightening slowly, and it does not sting, which matters because irritation on a sun spot can leave a darker mark. The effect is mild and takes months.
Lightens surface pigment modestly and adds a little to what sunscreen is doing during the day. It is easy to keep using for years, which is its real advantage here, since sun spots are a long game. On its own it will not clear an established spot.
Slows the handover of pigment from pigment cells to the skin cells above them, so a spot fades a little rather than disappears. Its strength is that it is well tolerated and does not sting, so it sits comfortably alongside a retinol without making the skin sore. Modest on its own.
Blocks the same pigment-making enzyme hydroquinone does, more weakly. It is nearly always sold combined with other lightening ingredients, and the studies behind it are studies of those combinations. It stings some people, and irritation on a sun spot is not a neutral event, particularly on medium and deeper skin tones.
An over-the-counter form of vitamin B3, taken as a tablet, which modestly reduced new actinic keratoses and new skin cancers in people at high risk. The effect is real but small, and it stops when the tablets stop. It is an add-on to sun protection and treatment, not a replacement for either. Check with your doctor before starting it.
The lower lip is the site almost nobody protects and one of the higher-risk places for a patch to progress. A balm with SPF 30 or higher, reapplied through the day, is the practical way to cover it. It will not treat a lip that is already persistently dry, scaly or cracked — that needs looking at.
The strongest cream for lightening a sun spot, applied thinly to the spot itself rather than the skin around it. It is used in a defined course of about three to four months with a break afterwards, not indefinitely, and it works best combined with a retinoid. It is slower than a single session of freezing or laser, and it is the option to prefer when treatment risk on deeper skin tones is the concern.
The prescription retinoid, and the one with real trial evidence in sun spots specifically. It lightens spots over about six to ten months and improves the sun-damaged skin around them at the same time. Expect dryness and flaking early on, and use it at night with daily sunscreen, since it leaves skin more sun-sensitive. Ask your doctor about it if you are pregnant or trying to become pregnant.
A stronger retinoid with good trial results in sun spots, used when tretinoin has not done enough. It works the same way, a little faster, and irritates more, so it is often started a few nights a week. Ask your doctor about it if you are pregnant or trying to become pregnant.
A prescription retinoid people often ask about here, because it is known for sun-damaged skin. It smooths texture and helps the mottled color, but trials have not shown that it clears actinic keratoses or prevents skin cancer. It is reasonable for the look of sun damage, and it is not a treatment for the patches themselves.
Fluorouracil cream (5-FU). The best-studied cream for treating a whole sun-damaged area rather than single spots, usually applied for two to four weeks. It attacks abnormal cells wherever they are, so it also clears patches that had not surfaced yet. The area becomes red, crusted and sore where those cells were, often revealing more than you knew you had — that reaction is the treatment working, and stopping early leaves the area half treated. If you are pregnant or breastfeeding, ask the doctor managing your pregnancy first.
Imiquimod cream. Prompts your own immune system to clear the abnormal cells, applied a few times a week over a longer course than fluorouracil. It also treats the whole field, and it can suit the face and scalp well. Expect redness and crusting, and sometimes a few days of feeling fluey. The same pregnancy advice applies: ask the doctor managing your pregnancy first.
Tirbanibulin ointment. A newer ointment used once a day for five days on the face or scalp. The short course and the milder reaction are the point of it — most people are through the redness and flaking within a couple of weeks. It is used on a limited area at a time, and long-term results are less well known than for fluorouracil.
An anti-inflammatory gel applied twice a day for two to three months. It is much gentler than fluorouracil, which makes it an option for people who cannot manage a strong reaction on visible skin. It clears fewer patches, and the course is long.
An oral retinoid used mainly for organ transplant recipients and others whose immune systems are suppressed, who make large numbers of these patches and progress from them more often. It reduces how many new patches and skin cancers appear while it is taken, and the benefit fades once it is stopped. It has real side effects and needs blood tests. It must never be taken in pregnancy, and pregnancy has to be avoided for three years afterwards.
A few seconds of liquid nitrogen on each spot, done in the room, no anesthetic needed. The spot darkens, crusts and lifts off over one to two weeks. It suits a small number of spots rather than a whole hand, and its known cost is a permanent pale mark where too many pigment cells were destroyed, which is a bigger risk on medium and deeper skin tones.
IPL. The best option when there are many spots across a whole area such as the face, chest or the backs of the hands. Usually one to three sessions, with the spots darkening and flaking off over one to two weeks after each. It is aimed at contrast between spot and skin, so it works best on lighter tones and is used cautiously or not at all on deep skin.
The same pigment-shattering laser used for tattoo ink is used at low energy on individual sun spots, and it clears them reliably in one or two sessions. It is more precise than intense pulsed light and better for a few stubborn spots rather than a whole area. Settings have to be matched to the skin tone, since too much energy leaves a pale or a dark mark behind.
Delivers its energy in much shorter pulses, which breaks up pigment with less heat spilling into the skin around it. That lower heat is the reason it is often chosen for medium and deeper skin tones, where a darker mark afterwards is the main worry. It costs more than the older lasers and the results in sun spots are broadly similar.
Lightens spots across a whole area rather than one at a time, which suits the backs of the hands, the forearms and the chest where spots are scattered widely. Usually a course rather than a single treatment, and the result is a general evening out rather than each spot disappearing. Depth matters: a peel strong enough to leave the skin raw can leave a darker mark instead.
Fraxel. Treats the sun-damaged skin as a whole rather than targeting individual spots, so it improves texture and fine lines alongside the pigment. That makes it a reasonable choice when the spots are only part of what is bothering you. For clearing spots alone it is slower, dearer and less precise than freezing or a pigment laser.
Polishes off the very top layer of skin, which makes it briefly smoother and brighter. The pigment in a sun spot is held in ridges below that layer, so it is not reached. It is often sold as a treatment for spots and it is not one, and repeated sessions can irritate skin enough to leave marks of their own.
Freezing with liquid nitrogen is the quickest option for a handful of separate patches, done in a few seconds each with no prescription. It stings sharply, then blisters or crusts and heals over one to three weeks. Its limit is that it only treats what can be seen, so new patches keep arriving from the damaged skin around them. It often leaves a permanently pale mark, which is more noticeable on deeper skin tones — worth asking about before you start.
A medium-depth peel takes off the damaged top layer across a whole face or scalp at once, so it treats the field rather than single spots. It is an option when creams have not been tolerated. The skin is red and peeling for about a week, and results depend a lot on who is doing it and at what strength.
A light-activated liquid is put on the whole area, left to soak in, then activated with a lamp. It treats a broad field in one or two clinic visits instead of weeks of cream, which suits people who cannot manage a long course at home. The area stings during treatment and is red, swollen and sore for several days, and the treated skin has to be kept out of light straight afterwards.
The thicker, harder patches that freezing struggles with are scraped away under local anesthetic and the base sealed. It is useful when a patch has built up into a lump or a horn, and the scraped material can be sent for testing. It leaves a small scar, and like freezing it treats only the spot in front of you.
Not a treatment, but the right answer for a patch that is thick, firm, tender, bleeding, growing quickly, bigger than about a centimeter, forming a horn, sitting on the lip or ear, or unchanged after proper treatment. A few minutes under local anesthetic tells you whether the abnormal cells are still confined to the top layer or have gone deeper. Freezing a patch like that instead removes the evidence without answering the question.
Sun spots usually persist and can increase with further ultraviolet exposure. They do not themselves become skin cancer, but sun-damaged skin can develop other lesions. A changing, rough or otherwise unusual spot needs assessment before cosmetic treatment.
Actinic keratoses are not steady. Individual spots come and go, which is one reason they get dismissed. The trend over years is upward.
Solar lentigines are benign, but they mark ultraviolet exposure and may coexist with other sun-damaged lesions. A changing or irregular spot needs assessment rather than an assumed age-spot diagnosis.
Squamous Cell Carcinoma
The skin cancer that these patches can turn into. Any one patch is unlikely to progress in any one year, but most squamous cell carcinomas begin in an actinic keratosis or in the damaged skin around one, and people usually have many patches over many years. Treating patches lowers how many of these appear later. A patch that thickens, hurts, itches, bleeds or grows quickly is sampled rather than frozen.
Actinic cheilitis on the lip
The same sun damage on the lower lip, where it shows up as persistent dryness, scaling, cracking or a lip border that has blurred into the skin. It is easy to read as chapped lips, and lip balm does not fix it. The lip matters more than its appearance suggests, because it is a higher-risk site if a patch progresses, so a dry scaly lower lip that has not settled in a month should be looked at.
Have a new, changing, unevenly colored or bleeding spot checked before using a fading treatment.
Arrange assessment of persistent rough spots. Rapid growth, tenderness, thickening, ulceration or bleeding raises concern for skin cancer.
The spots are harmless and do not turn into cancer. What they indicate matters - that much sun exposure makes other changes more likely, so watch and protect those areas.
The reassuring pattern is flat, one even color, a clear edge, stable over time, similar to its neighbors. The pattern that needs a check is changing, growing, more than one color, a ragged or blurred edge, itching, bleeding, or a spot unlike the rest. Being unsure is a reason to have it looked at, not to worry.
In-office treatment. Freezing works for a few spots; laser or intense pulsed light for many, usually over one to three sessions. Expect them to darken and flake off over one to two weeks. Creams work far more slowly.
The individual spot usually does not return. New ones keep appearing on sun-exposed skin unless the sun protection changes, which is why people who treat spots and change nothing else are back within a few years.
Sunscreen does not remove them, but it stops them darkening and slows new ones. Retinoids, vitamin C, niacinamide and short courses of hydroquinone lighten existing spots over three to six months, more gently than a procedure.
The one to be most cautious about. Freezing can destroy the pigment cells and leave a permanent pale mark, more noticeable on deeper skin tones and harder to correct than the original spot. Topical treatment first, conservative settings, a test spot, and a provider who treats deeper skin tones regularly is the safer path.
No. It is a precancer - abnormal cells in the top layer of skin that have not formed a tumor. A minority become squamous cell carcinoma, and they are treated because most squamous cell carcinomas begin this way.
Low, for any single patch in any single year. Published estimates vary too widely to quote. What matters is cumulative: more patches, for longer, with more sun. A suppressed immune system raises it considerably.
It stings for a few seconds and aches afterward. It blisters or crusts within a day or two and heals over one to three weeks. A pale mark often remains where the skin regrows with less pigment - sometimes permanent, and more noticeable on deeper skin tones.
That is how it works. Fluorouracil and imiquimod provoke a reaction exactly where abnormal cells are, so the area turns red, crusted and sore, often revealing more patches than you knew you had. It settles a couple of weeks after finishing. Stopping early leaves the area partly treated.
New ones almost certainly will, because the sun damage remains. That is not treatment failure. Most people settle into periodic checks, occasional retreatment and daily sun protection - the protection is what reduces how many new ones appear.
A few discrete patches, and freezing is efficient. Many patches, or a whole area of damaged skin, and a cream or photodynamic therapy lasts longer, because it reaches cells that have not surfaced yet. Downtime is part of the choice.
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