Sun Spots vs Freckles: How to Tell the Difference, And What to Do When You Find One

Ever spot something on your skin and wonder um, how long has that been there? Before you fall down the rabbit hole of Google, let’s start with step one: identifying what the spot in question actually is or isn’t. Most often, what you’re seeing is either the reemergence of freckles or a new sun spot. Allow our experts to explain the difference ahead.

• Dr. Elizabeth Hale is a board-certified dermatologist and a clinical associate professor of dermatology at the New York University Langone Medical Center. She’s also one of the preeminent national experts on skin cancer.
• Dr. Heather D. Rogers is a double board-certified dermatologist in Seattle and founder & CEO of Doctor Rogers Skin Care.

“Whether it’s just a few on your cheeks or in large clusters on your face, chest and arms, freckles are usually small (around 5mm in diameter each) and can appear brown, red, gray or black,” explains Hale, adding that freckles are “hereditary and are part of our DNA, but they will not show on your skin until they are activated by ultraviolet exposure from the sun.”

This is why you may notice that you have more freckles in the spring and summer months (and especially after a vacation where you’ve spent a lot of time in the sun). Freckles tend to lighten up in the fall and winter when you’re hunkering down at home more.

“Sun spots, also known as solar lentigines, are larger in size than freckles and typically show up as a single spot,” says Rogers. They’re traditionally found on the face, shoulders, hands, arms, back and top of feet and are sometimes also referred to as “liver” or “age” spots because they usually don’t show up until someone is in their late 30s or early 40s and beyond.

“With repeated UV exposure over the years, the skin cells start to produce melanin, which forms the actual sun spots. And unlike freckles, which can fade on their own over time, sun spots do not go away and are permanent unless treated,” adds Hale.

“There are various treatments that can lighten or reduce the appearance of freckles and sun spots such as lasers, serums and chemical peels, but I don’t recommend any of these treatments to my patients unless they can commit to daily sun protection to avoid further damage,” says Hale. (Ed note: As someone who has gotten their sun spots removed before, I can attest that these treatments can be highly effective, but the results won’t last if you don’t protect your skin.)

As another derm friend of ours told us previously, "The single best way to treat hyperpigmentation is to prevent it from developing to begin with.” You can do this by regularly using sunscreen and wearing protective clothing and hats whenever you’re outdoors.

Both Rogers and Hale recommend getting a spot looked at if it changes over time. “A spot that shows up and stays the same is unlikely to be a problem, but if it continues to grow, thickens or bleeds, you should have a dermatologist check it out,” explains Rogers.

Hale adds that, “If you have any new spots on your skin that look different from all others, if there’s a mole that has changed size, shape or color, if any of your spots are itching or you have sores that aren’t healing, it is important to see a health provider right away.”

“I’m particularly cautious of nonmelanoma skin cancer (NMSC), which is the most common form of skin cancer, affecting approximately 3.3 million Americans each year. NMSC includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) and usually develops on the skin that is often exposed to the sun such as the face, head and neck,” she says.

Some warning signs to watch for include:

• A dry, scaly patch or reddish spot that does not go away with lotion
• Flat pale or yellow areas
• Pearly bumps
• A pimple that won’t go away (basal cell carcinoma can present this way sometimes)

“It may be difficult to tell the difference between a run-of-the-mill dry patch and what could be nonmelanoma skin cancer, which is why I always recommend doing self-skin care checks regularly, as well as getting yearly skin checks done by your health provider,” she concludes.

For more information, check out SunRegrets.com, which is a campaign that Dr. Hale worked on to help educate people on NMSC, its causes, risks and what you can do to reduce UV damage.