What Is Hyperpigmentation? Recognizing Brown Spots and When to See a Doctor

• What it is: an area darker than the surrounding skin. When it comes from an excess of melanin, the skin's pigment, it is called hyperpigmentation. Its colour alone does not tell you what it is.
• What it could be: a freckle, a solar lentigo, melasma, a mark left by inflammation, a seborrheic keratosis or a mole. Only the doctor can tell them apart on examination.
• When to have it examined: a spot that is new, different from the others, changing, itchy, bleeding or not healing, or that shows one of the ABCDE signs.
• Who to see: a doctor, who examines the skin. A photo, a text or an online form is no substitute for that examination.
• Afterward: how much a mark can be faded depends on its cause, with no promise that it will disappear. Once the spot has been examined, what comes next is discussed at CARE MD in a Global Aesthetic consultation.

You have noticed a brown spot on your skin, on the face or on the body, and you want to know what it is and whether a doctor should see it. A spot is an area darker than the surrounding skin. What is hyperpigmentation? When a spot comes from an excess of melanin, the pigment that gives skin its colour, it is called hyperpigmentation. A brown mark can also be a different kind of lesion. Neither colour, nor shape, nor a photo found online is enough to identify a spot, and a misleading resemblance can even cause a skin cancer to be missed.

Whether a mark is described as brown, dark brown or black, or as a pigmented spot, these terms describe its colour. Sun exposure, inflammation or hormonal changes can contribute to pigmentation. But a brown lesion is not always caused by a simple excess of pigment: two marks of the same shade can be different kinds of lesions.

Where it is located gives some indication. Sun exposure mainly affects exposed areas; on the body as well as the face, a mark can also result from a pimple, irritation or an injury.

The freckles are small, flat marks ranging from light to dark brown. They become more noticeable in summer and fade in winter, and their number can increase after exposure to the sun's ultraviolet rays. Their seasonal changes distinguish them from lentigos, but are not enough to identify the mark you are looking at.

A solar lentigo is usually a flat mark that appears mostly on sun-exposed skin after years of exposure to ultraviolet rays. Unlike a freckle, it usually persists all year. However, not every persistent spot is a lentigo. If the mark is raised or you are unsure what it is, have it examined by a doctor: looking like a lentigo is not enough to identify it.

The condition known as melasma causes patches that are darker than the surrounding skin, most often on the face. It can appear during pregnancy or when hormonal contraception is started. Other conditions look similar: the context alone is not enough to identify it. It sometimes fades on its own, but can also last for years.

After a pimple, an irritation or an injury, the skin is sometimes left with a darker mark: this is post-inflammatory hyperpigmentation, the spot that remains after the pimple. A pimple or an injury can leave this mark, but that is not enough to identify it. If a spot appears without any inflammation that could explain it, do not assume it is the same thing.

Seborrheic keratosis often has a rough surface and a colour that ranges from pink to almost black. It looks stuck onto the skin, as if glued on. Flat at first, it often becomes more raised and wider over the years. Not every raised mark is one, and a very dark keratosis can look like a melanoma: a brown or black lesion that changes should be examined.

A mole can be flat or slightly raised, and these features are not enough to identify it with certainty. Unlike a mark left by inflammation, a new mole or one that changes in an adult can be a sign of melanoma. Have it examined by a doctor.

A dry, rough, scaly mark is not necessarily a spot: it may be an actinic keratosis, which may develop into skin cancer. It should be examined, not treated as a mere blemish.

To help the doctor, describe what happened before the spot appeared; you do not have to identify it yourself. Exposure to ultraviolet rays can increase the number of freckles, while years of exposure contribute to solar lentigos. Inflammation can also leave a mark, whether it comes from a pimple, an injury or a product that irritates the skin. For melasma, pregnancy or the start of hormonal contraception can be part of the picture. Several of these causes can occur together in the same person, and none applies to every spot.

On medium to dark skin tones, various triggers stimulate the skin to produce more melanin, and irritation from a skin care product sometimes leaves a darker mark. Whatever your skin colour, do not put a new or changing spot down to irritation without having it examined.

The five ABCDE signs indicate when to ask for medical advice. They help you notice a change, not make a diagnosis. A spot may need to be examined even if none of these signs appears.

Other signs matter even if no ABCDE sign appears: a new spot, a spot that itches or bleeds, a sore that does not heal or that comes back after healing. A single one of these signs is enough to justify an examination. The ABCDE signs help recognize a melanoma, without replacing the examination: a change or a suspicious feature calls for medical advice.

In Canada, the assessment of a suspicious spot usually begins with the family doctor: they ask questions, examine the skin and may refer you to a specialist. If you notice a change in your skin, tell them promptly.

Before the appointment, note when the spot appeared, how it has changed, whether it itches or bleeds, and whether you or a close family member have ever had skin cancer. This information helps the doctor understand how the spot has developed; the doctor also has to examine the skin.

Comparing your spot with photos found online is no substitute for an examination: two marks that look alike can be very different. The CARE MD form is for asking a question about an aesthetic treatment, not for having a spot assessed. If your spot shows one of these warning signs, have it examined by a doctor first.

Once the mark has been examined and identified as pigmentation, you may want to fade it. On the face, the assessment of brown spots on the face is an opportunity to discuss suitable options, their limitations and their risks. You can discuss these in a Global Aesthetic consultation at CARE MD. An aesthetic treatment must never come before the examination of a new or changing mark.