Identify the Risky Spots… Get Rid of the Rest with Topical Cream

One unfortunate result of years of sun exposure is age spots — also known, for no good reason, as liver spots (they have absolutely nothing to do with the liver). Generally small and flat, these are usually brown, all of one shade, which may be anywhere from the color of dark coffee to light tan. They tend to appear in people over the age of 40, most commonly on skin that’s been most exposed to sun — the face, arms, backs of the hands and shoulders.


Though many consider them unattractive, age spots are generally harmless. Dermatologists report that requests for removal are quite common, if not medically necessary. “These are simply what happens when melanocytes, the cells that create melanin, get busy and make too much pigment in one spot,” Audrey Kunin, MD, dermatologist and founder of, explained. Melanin is the dark pigment that skin cells produce in response to sunlight, causing your skin to tan.

Short of removal, the most common treatment is a topical medication called hydroquinone, the only active ingredient that can legally be marketed for over-the-counter use for bleaching the skin. For topical use, many over-the-counter creams are available at a strength of 2%, while stronger concentrations of 3% to 4% are available by prescription. Some patients find that skin-rejuvenation products, especially the topical retinoids like Retin A, are also helpful, Dr. Kunin said. The most potent ones are available only by prescription.

Also, a variety of simple procedures can be used to help diminish these unattractive spots. For instance, exfoliating procedures such as microdermabrasion or chemical peels can lift away pigment that has been deposited high up in the epidermis. The use of home glycolic acid-based skin treatments and microdermabrasion creams can also be useful. And certain types of lasers can literally blast the pigment deposits into less visible fragments.


While age spots are of no concern most of the time, very infrequently they can develop into skin cancer. This can be a particular challenge since it can be hard to distinguish which ones are precancerous or actually cancer. Age or liver spots can be difficult to differentiate from actinic keratoses (though these tend to be flatter, scaly and more often reddish-brown than true brown), which turn into squamous cell carcinoma (a kind of skin cancer) 10% to 25% of the time. Another concern is melanoma, which 1% of the population is at risk for developing in their lifetime. Sometimes a melanoma in its earliest stages can look like an age spot. If you feel unsure or are concerned, visit your dermatologist. “It’s far better to be safe than sorry,” says Dr. Kunin.

Dr. Kunin recommends that all adults receive a complete skin exam by age 25 and then annually or more often if anything is concerning or changing… and then make decisions on follow-up together with your physician.

Age Spots are…

  • Smooth and flat
  • Light brown to dark brown
  • Larger than a freckle
  • Appear on sun-exposed areas
  • Not flaky or scaly


See a dermatologist if any spot exhibits any of these signs…

  • Change in size
  • Irregular border
  • Unusual color or varying colors within the spot, including black, brown or tan shades
  • Asymmetry

Actinic Keratoses

These should always be removed, typically by freezing or burning with electrical current or a laser. They are…

  • Rough and wart-like
  • Brown, pink, red or flesh-colored
  • Flat and scaly, or hard and slightly elevated

To view what melanoma and actinic keratoses look like, go to the American Academy of Dermatology’s consumer site,