Age Spot Or Precancerous Skin Lesion?

Age spots are very common—but not every skin change referred to as such in everyday life is harmless. Chronic UV exposure can lead not only to benign pigmented spots but also to actinic keratoses or other precancerous skin conditions. What makes this particularly insidious is that the consequences often don’t become apparent until decades later.

Any age spot that changes should be evaluated by a doctor. Dr. Robert Rongisch, Medical Director of the Jungbrunnen Clinic in Bonn, explains in an interview which changes should not be ignored and why a specialist diagnosis is crucial before undergoing cosmetic treatments. He also describes the modern treatment options available today.

Age spot or precancerous skin lesion: How can you tell the difference?

The term “age spot” is used very loosely in everyday language. Medically, we usually refer to lentigines solares/seniles: benign pigmented lesions resulting from chronic UV exposure. In contrast, there are precancerous skin lesions that must be clinically distinguished. These include, for example, actinic keratoses (a precursor to a form of “white skin cancer”)

Rough, sandpaper-like, scaly, reddish plaques) or lentigo maligna (melanoma in situ, a precursor to “black skin cancer”). These changes cannot always be reliably distinguished with the naked eye, which is why new, growing, or changing pigmented spots, as well as skin lesions that do not heal, should always be examined by a specialist using dermoscopy.

What role does UV radiation play, and why are its effects often not visible until decades later?

Sunlight contains different types of UV rays. Both UVA and UVB radiation can damage the genetic material of skin cells and, over the long term, increase the risk of skin cancer if the skin’s repair mechanisms become overwhelmed over time.

UVB radiation
… is primarily responsible for sunburn. Short, intense exposures to UVB radiation and sunburns (e.g., during childhood) increase the risk of “black skin cancer” (melanoma).

UVA radiation
… penetrates deeper into the skin, is present year-round, and is effective even in the shade or behind glass. It causes cumulative damage to the skin, promotes premature skin aging, and plays an important role in the development of “non-melanoma skin cancer.”

What skin changes shouldn’t you simply dismiss as age spots, and when should you see a dermatologist?

As a general rule, any changes in the skin that do not clearly appear to be benign—whether they are new, changing, growing, bleeding, itchy, or not healing—should be evaluated by a dermatologist.

Can actinic keratosis really develop into skin cancer, and how high is that risk?

Yes. Actinic keratosis is considered an early form of squamous cell carcinoma. Individual lesions carry a limited risk of malignant transformation, but the likelihood increases significantly with multiple lesions. If left untreated, they can progress to invasive “white skin cancer.” Guidelines from the Deutsche Dermatologische Gesellschaft and the AWMF therefore recommend consistent treatment of all clinically relevant actinic keratoses.

Why is it problematic to have pigmented spots removed for cosmetic reasons without first having them medically evaluated?

Cosmetic procedures remove pigment, not the underlying condition. As a result, skin cancer (or its precursors) can be overlooked or masked. Therefore, a consultation with a dermatologist is absolutely essential before any cosmetic treatment.

What treatment options are available for actinic keratoses, ranging from creams to cryotherapy to lasers?

Depending on the extent, location, and patient’s situation, various treatment options are available. These include topical cream therapy, cryotherapy, ablative laser procedures (e.g., Er:YAG), surgical procedures, and photodynamic therapy (PDT). A modern and effective option is laser-assisted PDT, in which the skin is first pretreated with a fractional laser (e.g., CO₂) to improve the penetration of the active ingredient. Especially on the face, this method is now a state-of-the-art option for extensive actinic damage.

What exactly happens during laser treatment for age spots, and who is it suitable for?

The laser selectively targets melanin. The pigment is broken down while the surrounding tissue is largely spared. This method is suitable only for cases where the lesion has been clearly diagnosed as benign by a dermatologist and, if necessary, confirmed by histological examination.

Which skin types are particularly at risk for age spots or actinic keratoses?

People with fair skin and those with high UV exposure or immune deficiency are particularly at risk

How can you prevent age spots and actinic keratoses?

Consistent UV protection is the most important preventive measure—and not just in later life! The UV index is a helpful tool in this regard, as it reflects the current daily UV exposure. When the UV index reaches 3 or higher, it is recommended to use enhanced sun protection (SPF 50 + UVA protection). UV exposure can be high even on cloudy days, in the spring, or in the mountains. Sun protection is therefore not just for vacations, but should be based on the actual UV exposure.

About Dr. Robert Rongisch, M.D.
He is the Medical Director of the Jungbrunnen-Klinik in Bonn and a specialist in dermatology and venereology.

About the Jungbrunnen-Klinik
The private Jungbrunnen-Klinik GmbH offers a harmonious blend of architectural style and therapeutic expertise across more than 1,200 square meters. Dermatology and aesthetic dermatology, phlebology and laser medicine, as well as plastic and reconstructive surgery, form a holistic alliance. The physicians in the Department of Plastic and Aesthetic Surgery, the collaborating physicians, and the 15 staff members are a well-coordinated team.

Photos: Jungbrunnenklinik (3)