“Doctor, I am getting spots on my face, I hope it is not cancerous. How can I get rid of them?”

This is a concern we frequently hear in dermatology clinics. Spots on the face can be alarming—not only for cosmetic reasons but also due to the fear of them being cancerous. Fortunately, the majority of facial spots are benign and manageable with simple dermatological treatments. However, it is essential to understand what these spots signify and when to seek medical attention. In this guide, we explain the most common types of facial spots, their causes, treatment options, and red flags to watch for.

Are All Dark Spots Dangerous?

Not necessarily. While some facial lesions can resemble cancerous growths, most are harmless and treatable. Accurate diagnosis is the key. Dermatologists are trained to differentiate between benign and suspicious lesions and can help you safely and effectively reduce or remove these spots. However, some spots, such as Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma, can be cancerous and require prompt attention.

Common Causes of Dark Spots on the Face

1. Moles (Melanocytic Nevi)

• Appearance: Brown or black round raised spots; can occur on any body part.

• Onset: Often develop during adolescence, not necessarily present from birth.

• Changes Over Time: Moles may grow, change colour, develop hair, or flatten.

• Treatment: Can be removed easily by a dermatologist using excision, laser, or radiofrequency.

• When to Worry: If a mole changes in size, colour, shape, bleeds, itches, or develops a raw surface—consult your dermatologist to rule out melanoma.

2. Skin Tags (Acrochordons)

• Appearance: Small, soft, hanging outgrowths of skin.

• Location: Commonly seen on the neck, eyelids, underarms, or groin.

• Associated Factors: More common in obese individuals or those with diabetes or insulin resistance.

• Treatment: Easily removed by a dermatologist using cautery, cryotherapy, or laser.

3. Seborrheic Keratosis (Age Spots)

• Appearance: Brown or black, rough, raised patches that feel like sandpaper.

• Common Age: More frequent in people over 40 years.

• Differentiation: Often confused with freckles, but unlike freckles, they are palpable.

• Treatment: Removed via laser, cryotherapy, or radiofrequency ablation.

4. Milia

• Appearance: Tiny white bumps commonly found around the eyes and cheeks.

• Cause: Trapped keratin under the skin due to occlusive creams or sun damage.

• Treatment: Can be extracted using a sterile needle by a dermatologist.

• Prevention: Use lightweight moisturizers and broad-spectrum sunscreen regularly.

5. Sebaceous Hyperplasia

• Appearance: Yellowish-pink bumps, often with a central depression.

• Location: Predominantly on the T-zone in individuals with oily, thick skin.

• Treatment: May be reduced using laser, electrocautery, or topical retinoids.

6. Cherry Angiomas

• Appearance: Small, red, blood-filled papules.

• Location: More common on the trunk and limbs.

• Cause: Age-related vascular changes.

• Treatment: Easily removed by laser or electrocautery for cosmetic reasons.

7. Post-Inflammatory Hyperpigmentation (PIH)

• Appearance: Dark spots that appear after an inflammatory skin condition like acne, eczema, or psoriasis.

• Cause: The skin produces excess melanin after an injury or inflammation.

• Treatment: Use of brightening agents such as vitamin C, niacinamide, and retinoids, along with sun protection to prevent further darkening.

8. Sunspots (Lentigines)

• Appearance: Flat, brown spots caused by prolonged sun exposure.

• Cause: UV radiation increases melanin production, leading to these spots over time.

• Prevention: Regular sunscreen application and avoiding prolonged sun exposure.

• Treatment: Laser treatments or chemical peels can help lighten these spots.

9. Melasma

• Appearance: Brown or grayish-brown patches, often on the cheeks, forehead, and upper lip.

• Cause: Hormonal changes (e.g., pregnancy, birth control), UV exposure, or genetics.

• Treatment: Topical treatments such as hydroquinone, retinoids, or chemical peels. Consistent sun protection is critical to managing melasma.

10. Freckles (Ephelides)

• Appearance: Small, light brown spots that are flat and typically appear on sun-exposed areas.

• Cause: Genetic predisposition and sun exposure.

• Prevention: Regular sun protection can help prevent the formation of new freckles.

• Treatment: Can be lightened using topical treatments like vitamin C or laser therapy for cosmetic purposes.

11. Acanthosis Nigricans

• Appearance: Dark, thickened patches of skin, usually around the neck, armpits, or groin.

• Cause: Often linked to insulin resistance, obesity, or hormonal imbalances.

• Treatment: Addressing the underlying condition, using topical treatments like retinoids, and weight management.

12. Blackheads (Open Comedones)

• Appearance: Small, dark spots with a clogged pore that appears as a dark “plug.”

• Cause: Blockage of hair follicles with oil and dead skin cells, oxidizing the sebum.

• Treatment: Regular exfoliation, topical retinoids, and gentle extraction by a dermatologist.

  13. Basal Cell Carcinoma (BCC)

  • Appearance: A pearly or waxy bump, often with visible blood vessels; may appear as a scar-like flat area or ulcer.

  • Location: Commonly on sun-exposed areas like the face, ears, and neck.

  • Signs: Slow-growing, non-healing wounds or raised spots with a shiny, translucent appearance.

  • Treatment: Usually excised surgically, sometimes treated with Mohs micrographic surgery.

    14. Squamous Cell Carcinoma (SCC)

    • Appearance: A red, scaly patch, ulcer, or nodule that may crust or bleed.

    • Location: Commonly on the face, ears, lips, or hands.

    • Signs: A thick, rough patch that can be painful or tender, often developing from a precancerous actinic keratosis.

    • Treatment: Surgical excision, cryotherapy, or radiation.

    15. Melanoma

    • Appearance: Asymmetrical, irregularly shaped mole with uneven borders, multiple colours (black, brown, blue, red), and varying sizes.

    • Location: Can appear anywhere on the body but is most common on the back, legs, or face.

    • Signs: Rapid growth, colour changes, bleeding, itching, or crusting. Melanoma is often aggressive and spreads quickly.

    • Treatment: Surgical excision followed by possible chemotherapy, immunotherapy, or radiation, depending on the stage.

Distinguishing Dark Spots: A Quick Guide

Below is a table to help you distinguish between various types of dark spots and bumps on the skin:

When Should You See a Dermatologist?

You should seek professional evaluation in the following scenarios:

• A spot or mole changes in size, shape, or colour

• It bleeds, itches, or becomes painful or ulcerated

• You’re unsure about the diagnosis and need confirmation

• You wish to remove spots for cosmetic enhancement

While most dark spots are benign, ruling out skin cancer—especially melanoma—is essential if there is any suspicion.

Conclusion

Dark spots on the face can result from a variety of benign skin conditions such as moles, skin tags, age spots, milia, or angiomas. Most are harmless and treatable. However, any change in appearance or new development warrants an expert opinion to rule out malignancy. With accurate diagnosis and timely intervention, dermatologists can help you achieve clearer, healthier skin.