These small spots on your face aren’t freckles, they’re…see more

You’ve had them for years, these small, flat, brownish spots scattered across your cheeks, forehead, or nose. You call them freckles, and everyone else does too. They seem harmless, a permanent feature of your landscape. But true freckles (ephelides) are fickle—they darken in the sun and often fade in winter. If your spots are constant, unchanging companions regardless of the season, they aren’t freckles. They are most likely solar lentigines, commonly known as sun spots or liver spots. And they are not a genetic quirk; they are your skin’s permanent, typewritten record of cumulative sun damage.

The difference is profound. A freckle is a genetic tendency. A solar lentigo is a sun-induced scar.

The Origin Story: A Sunburn’s Permanent Signature

Here’s how they form, and why they’re a more serious bulletin than you think:

1. The Insult: Ultraviolet (UV) radiation from the sun penetrates your skin. Unlike a freckle, which appears due to a sun-triggered but genetically programmed distribution of melanin, a solar lentigo forms when UV radiation causes a localized hyperplasia—an abnormal overgrowth of melanocytes (pigment-producing cells) in a specific spot.
2. The Overreaction: In that tiny patch of skin, the melanocytes go into overdrive, producing an excess of melanin. Think of it as a tiny, panicked factory that can’t shut down.
3. The Permanent Stamp: This overgrowth and excess pigment become a fixed part of your skin’s structure. It doesn’t fade because the number of pigment cells themselves has increased. It’s not a temporary stain; it’s a rewiring of that small patch of skin.

Why They Matter: They’re More Than a Cosmetic Concern

Calling them “sun spots” minimizes their significance. They are, in medical terms, benign keratinocytic proliferations. But their presence is a critical signal:

• They Are a Direct Measure of Your Lifetime Sun Exposure. Each one is like a tick mark on a ledger, counting past sunburns, tanning bed sessions, and long days spent without protection.
• They Are a Marker for Increased Skin Cancer Risk. Having multiple solar lentigines is a clinical sign that your skin has sustained significant UV damage. This damage is what leads to mutations that can cause basal cell carcinoma, squamous cell carcinoma, and melanoma. If you have these spots, your skin is in the “high-risk” category for future cancers. They are the visible warning that the invisible damage is extensive.
• They Reveal Your Most Vulnerable Skin. They often appear first on the face, décolletage, forearms, and hands—the areas of chronic, everyday sun exposure, not just occasional burns.

How to Tell Them Apart from Freckles

• Freckles (Ephelides): Light brown or reddish, small, often numerous. Blur in winter, become prominent in summer. Typically appear in childhood on fair skin. Borders are fuzzy.
• Solar Lentigines (“Sun Spots”): Tan to dark brown, can be larger. Do not fade in winter. First appear in adulthood (30s, 40s+). Borders are sharper, more defined. Feel completely flat.

Your Action Plan: From Observation to Protection

Seeing these spots as sun scars changes everything. Your strategy shifts from concealment to prevention and vigilance.

1. Stop Calling Them Freckles. This reframes them in your mind as damage, not decoration.
2. Become a Sun Zealot, Not a Sun Bather:
   • Daily, Year-Round Broad-Spectrum SPF 30+: On face, neck, chest, and hands. Every. Single. Day. Rain or shine.
   • Seek Shade & Wear Hats: Make wide-brimmed hats and sun-protective clothing non-negotiable.
   • Absolutely No Tanning Beds. Ever.
3. Schedule a Professional Skin Check. Show these spots to a dermatologist. A yearly full-body exam is crucial. The dermatologist will map them and look for any changing or suspicious lesions among them.
4. Consider Treatment (For Cosmetic & Monitoring Reasons): While not medically required, removal can be pursued and aids in monitoring. Options include:
   • Prescription Topicals: Retinoids (tretinoin) or fading creams (hydroquinone).
   • Laser Therapy (IPL or Q-switched lasers): Highly effective at targeting pigment.
   • Cryotherapy: Freezing individual spots with liquid nitrogen.

These small spots on your face are your skin’s autobiography, written in melanin. They are chapters titled “Beach Vacation, 1998,” “No Sunscreen, 2005,” and “Driving with the Window Down.” They are not freckles. They are your face quietly telling you the story of every ultraviolet ray it has ever absorbed—and issuing a firm, visible warning to protect the skin you have left. By listening to this story, you can write a safer next chapter.