Freckles - harmful or not?

Freckles are harmless. They may, however, sometimes be confused with more serious skin problems. Conversely, more serious problems such as skin cancer may at times be passed over as a mere freckle. Anyone who has one or more pigmented spots, of which they are not certain, should be seen by a dermatologist. Treatments are available to lighten or eliminate those freckles whose appearance bothers their owners.


What are freckles?

Freckles are flat, tanned circular spots that typically are the size of the head of a common nail. The spots are multiple and may develop on sun-exposed skin after repeated exposure to sunlight. These are particularly common in people of fair complexion on upper-body skin areas like the cheeks, nose, arms, and upper shoulders. They may appear on people as young as 1 or 2 years of age.

Most freckles are uniform in colour.  On different people, freckles may vary somewhat in colour -- they may be reddish, yellow, tan, light brown, brown, or black -- but they are basically slightly darker than the surrounding skin. They may become darker and more apparent after sun exposure and lighten in the winter months.

How do freckles develop?

Freckles are thought to develop as a result of a combination of genetic tendency (inheritance) and sun exposure. Two people receiving the same sun exposure may not have an equal chance of developing freckles. Natural sunlight and artificial sun tanning lights emit ultraviolet (UV) rays. After exposure to ultraviolet rays, the outer layer of the skin (epidermis) thickens and the pigment-producing cells (melanocytes) produce the pigment melanin at an increased rate. This production of melanin may give some protection against future sun exposure.

Freckling is caused by the uneven distribution of the melanin pigment in the skin. A freckle is essentially nothing more than an unusually heavy deposit of melanin at one spot in the skin.

What is the medical meaning of freckles?

True freckles pose essentially no health risk at all. They are all absolutely harmless. They are not cancerous and generally do not become cancerous. Rare concerns about freckles may arise when they are associated with other diseases or when they are confused with the following, more serious conditions:

  • Malignant freckle: This is an uncommon superficial skin cancer that generally occurs on the faces of older adults who have a history of considerable sun exposure. There are, of course, many hundreds of ordinary facial freckles for every one that is potentially malignant.
  • Melanoma: This very dangerous form of skin cancer that may appear even in young people and on parts of the body that is sun-exposed as well as those that are protected. While the exact cause of melanoma is not entirely known, ultraviolet rays are known to play a part. Melanomas can arise from a previously normal mole or pigmented spot that has been present many years or lifelong. Melanomas can also arise from completely normal skin without an apparent pre-existing mole. In comparison with benign (noncancerous) freckles, melanomas tend to be larger, darker, and have more irregular colour and shape variations. Most melanomas are actually flat and not raised as many people tend to incorrectly assume.
  • Basal cell carcinoma: This is the most common type of skin cancer. These are usually pearly, pink or reddish in colour, and may bleed easily. Pigmented basal cell carcinoma is a type of basal cell that may be confused with a freckle because of its brown or dark colour. A simple procedure called a skin biopsy can help diagnose this growth.

A warning

Anyone who has one or more uncertain pigmented spots should have their dermatologist evaluate them. Even verbal descriptions and photographs cannot convey enough information for satisfactory self-diagnosis. As always, it’s better to be safe than sorry.


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