"Age spots" or "liver spots" are usually flat, brown, uniformly colored marks called lentigos (freckles). They have nothing to do with the liver. Lentigos usually appear on the face, hands, back and feet and are promoted by chronic sun exposure in more mature skin. TRUE BENIGN LENTIGOS are harmless and do not turn into melanoma or skin cancer. There are commercial fading creams, but these are not usually strong enough to completely fade all lentigos. On occasion, there may be malignant or atypical lentigos that display irregular coloration and/or other traits. Age spots that are elevated, greasy, usually dark and contain little "pearls" are seborrheic keratoses. Sometimes it is a natural progression of certain types of lentigos to turn into seborrheic keratoses. See Seborrheic Keratosis.

One of the best treatments to remove lentigos is freezing them delicately with LIQUID NITROGEN. Pigmented cells in the skin are extremely sensitive to cold. An over-the-counter or prescription bleaching cream to fade any small remnants may help following the liquid nitrogen treatment. Freezing may take several treatments for the best results. The author prefers to slightly under-freeze during the first treatment, as everyone's skin is different; some skin, e.g., red freckled skin, is overly sensitive to cold and may develop permanent white areas, while some may remain pink longer. Since benign lentigos do not cause any physical harm, most insurance companies and Medicare do NOT cover their removal and consider them cosmetic in nature. For lentigos that resist liquid nitrogen, several laser treatments may help.

LASER is usually an effective but expensive way to remove lentigos. Numerous types of lasers are in use for removing skin lesions. The Ruby Laser was once among the more selective and effective for treating lentigos. The author, featured in a front page article in USA Today newspaper, was one of the first dermatologists in the United States trained in the use of the Ruby Laser to remove lentigos and other lesions. Keep in mind that in many patients, the results of "old-fashioned" liquid nitrogen and "hi-tech" lasers are identical! This is because the light of the laser targets affects the same lentigo cells, which are, as noted above, also especially sensitive to liquid-nitrogen freezing! Laser treatments are usually much more expensive to use than nitrogen or creams. This is because a LASER unit itself costs a doctor or hospital tens or hundreds of thousands of dollars, in addition to the costs of installation and continual monthly or annual maintenance and repair (often 10% of the cost of the laser per year).

On the other hand, LASERS and IPL (Intense Pulsed Light) systems do offer some advantages over liquid nitrogen in some selected patients, namely those patients whose skin may whiten or redden following liquid-nitrogen treatment. It is only in these selected patients that the author initially recommends such systems. BEWARE: common carbon-dioxides laser used by other doctors may or should lower the costs of laser treatment because of system cost decreases, but most models offer few, if any, advantages over liquid nitrogen. Patients will probably pay more for the carbon-dioxide laser treatments (especially with older LASER units) and risk a higher chance of scarring than with most other procedures that are used to remove lentigos.

Small spot chemical peels, with agents such as chloroacetic acid are also an excellent alternative to Laser, IPL, and liquid nitrogen. Do Not Forget: Continued sun exposure and maturity (time) may cause lentigos (freckles) to return. To grow more lentigos in a treated area is a natural event.