Pigmented Lesions

Types of Pigmented Lesions

Pigmented lesions are caused by an excess of melanin in certain skin cells (melanin is the substance that gives skin its color). Types of pigmented lesions include:


Spots which are the light brown color of milky coffee. These can be small or very large and can appear on any part of the body.

Nevus of Ota

Pigmented birthmark which can be very large and occurs on the face. It is most common in Asian skin.


Freckles, also called ephilides, are very small spots of concentrated pigment stimulated by the sun that tend to remain in stable locations on sun exposed areas. This is, of course, a very common condition.

Age spots (lentigines)

Age spots, also called liver spots or lentigines are abnormal pigment accumulations in the epidermis due to many years of sun exposure. They occur on the face, neck and chest and back as well as the forearms and hands.

Pigmented lesions, birthmarks, brown spots and age spots are created from an excessive concentration of melanin in the skin. Melanin is what gives our skin its color. Everyone has a different amount of melanin in his or her skin. Your physician will evaluate your skin and inform you of the specific type of skin lesion. High concentrations of melanin can be due to various factors. Some types are present at birth, but most occur with age or as a result of overexposure to the sun's damaging rays.

Classification of congenital vascular birthmarks has historically been confusing. The medical literature has been inundated by an assortment of terminologies, including hemangioma, nevus flammeus, "stork bites" and port-wine stains. Hemangioma became the generic term used to describe a variety of acquired and congenital vascular lesions. Because this classification was so broad, however, it led to confusion regarding prognosis.

Lesions that develop by undergoing an initial phase of rapid proliferation followed by cessation of growth and involution are classified as hemangioma. Vascular birthmarks that persist throughout the patient's lifetime and grow commensurately are classified as vascular malformation; this group includes port-wine stains.

Hemangiomas tend not to be present at birth but appear during the first few days to weeks of life, often as single small macules. These lesions grow rapidly, becoming red and raised. The lesions increase in size during the following weeks to months, until the child reaches about 12 months of age, when growth stops. Hemangiomas occur most frequently on the face or neck and tend to vary in size from a few millimeters to many centimeters in diameter.

The fully developed hemangioma is often dome-shaped, ranging in color from bright red to dark purple. Approximately 50 percent of hemangiomas spontaneously involutes (diminish) by the time the child is five years of age. Vascular malformations (port-wine stains) are almost always present at birth and occur with equal frequency in males and females.

The port-wine or red color of these lesions is a consequence of enlarged, ectatic (expansion) blood vessels in the dermis, rather than an increase in the number of blood vessels. The incidence of port-wine stains is estimated to be 0.3 percent; 80 to 95 percent are located on the head and neck. Most port-wine stains appear to involve only the skin; however, approximately 5 percent of patients with port-wine stains have concomitant leptomeningeal involvement (Sturge-Weber syndrome) and/or ocular involvement.

At birth, port-wine stains appear as pale pink macules. They darken with age, becoming red to purple, and often develop small nodules within the birthmark, which give the lesions a studded appearance. In extensive lesions, hypertrophy of underlying soft tissues often occurs. These lesions result from blood vessels which become enlarged (or dilated), such as port-wine stains (red birthmarks like Mikhail Gorbachev's) or spider veins. They can also appear when too many blood vessels grow in an area, such as hemangiomas.

The most commonly treated conditions are solar lentigines, also known as "age spots," "liver spots" or "sun spots"; cafe' au lait birthmarks; and freckles. These benign pigmented lesions are due to an excess of pigment in the skin, usually due to sunlight exposure and congenital factors. Age spots may appear as enlarged light freckles on the face and hands. Cafe' au lait birthmarks may appear as light brown markings anywhere on the body and can be quite large.

Treatments of Pigmented Lesions are listed below. Note that before making a decision about which type you'd like, its best to discuss your particular circumstances with one of our dermatologists.

Please note that this information should be used only as a guide to your treatment. All specifics will be discussed with your Physician at your consultation.

If you have questions that are not answered in this website, then please contact us.

Most pigmented lesions if completely removed will not return. At times, however, sun exposure may cause café-au-lait spots to return. Permanence can not be guaranteed. You will also continue to develop more age spots and freckles with time, and the appearance of these new lesions should not be confused with recurrence.

Pigmented lesions and age spots are cosmetic problems that do not require treatment for medical reasons. Topical therapies include the use of tretinoin (Retin-A), topical vitamin-C or fade creams. These topical therapies are an option, but the results are unpredictable and the response time is 6 months or more for improvement. Make-up is also an option. Cryotherapy can improve pigmented lesions, but often leaves white unpigmented areas or small scars.

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