Freckles, lentigines, and solar lentigines are benign, light brown skin lesions that result from an increase in melanin produced by melanocytes. Although they may appear similar in distribution and clinical appearance, they differ in terms of age of onset, clinical progression, and their relationship to sun exposure.
Freckles do not involve an increased number of melanocytes (the cells that produce melanin), but rather melanocytes that overproduce melanosomes, which alters the pigmentation of the outer skin cells. They are linked to heredity and commonly appear in fair-skinned individuals as a result of exposure to sunlight.
Freckles appear as brown spots on the skin, most commonly on the face, chest, back, and upper limbs. Freckles typically appear during childhood as well-defined, uniformly pigmented spots measuring 1–2 mm in diameter. Their color ranges from reddish-brown to light brown and they are usually found on the face, arms, and upper torso. With sun exposure, they increase in number and darken in color, while in the winter, they may disappear completely. Lentigines (lentigo simplex – lentigines) are very common in individuals of Caucasian descent and usually appear during childhood. They are larger and darker than freckles and do not increase in size or darken with sun exposure. Juvenile lentigines may also be associated with certain genetic syndromes such as Peutz-Jeghers, LEOPARD, LAMB, or NAME.
Genital lentigines are acquired, light or dark brown spots that appear during adulthood. They remain stable over time and are typically located in the perianal region, on the penis, and the vulva. Solar lentigines (sun spots) are caused by the damaging effects of ultraviolet radiation. They are usually larger in diameter (2–20 mm) and may be oval-shaped or have other geometric forms. They are typically uniformly pigmented, although sometimes their surface may appear mottled. The surrounding skin often shows signs of solar elastosis. Their borders should be well-defined, and there should be no signs of significant hyperpigmentation or hypopigmentation on their surface — otherwise, they must be differentiated from melanoma.
Freckles, lentigines, and solar lentigines should be differentiated from junctional melanocytic nevi, pigmented actinic keratosis, pigmented seborrheic keratosis, and lentigo maligna (melanoma). The distinction is made based on medical history, clinical appearance, dermatoscopic findings, and in uncertain cases, on histological findings following a biopsy.
Freckles and lentigines do not require treatment. Solar lentigines, which remain stable, are treated only for cosmetic reasons. Topical treatments with hydroquinone, azelaic acid, vitamin A, and glycolic acid are recommended. Cryotherapy is also suggested for their removal.
In our clinic, we achieve very good therapeutic results using the Q-switched laser and Pico Laser. However, this treatment is not recommended during the summer months, as exposure to sunlight should be avoided.
The treatment of freckles is particularly demanding, and even in cases of complete removal, there is still a possibility of recurrence in the same or a different area of the body, even after applying all recommended sun protection measures.
A freckle is not a dangerous lesion for your health. However, it can resemble more serious lesions, such as lentigo maligna (a type of melanoma). For this reason, the most qualified person to provide a definitive diagnosis is a dermatologist.
A freckle is not a dangerous lesion to your health; however, it can resemble more serious lesions, such as lentigo maligna (a type of skin cancer). Therefore, the most qualified person to make a definitive diagnosis is the dermatologist.