09/06/2025
Derm Index: Understanding Lentigines
Lentigines, commonly referred to as liver spots or age spots, are benign pigmented lesions that typically appear on sun-exposed areas of the body, such as the face, backs of the hands, shoulders, and forearms. These lesions are particularly prevalent among middle-aged and older individuals, as their incidence increases with age. Lentigines can range in size from 0.2 to 2 cm in diameter, and they typically have well-defined borders, an irregular shape, and a dark brown to black color. They are flat, non-palpable lesions that may occasionally show varying degrees of pigmentation.
Pathophysiology
Lentigines are caused by an increase in the number of melanocytes (pigment-producing cells) within the epidermis, particularly in the basal layer of the skin. This hyperpigmentation results from a localized overproduction of melanin, which is stimulated by ultraviolet (UV) radiation exposure over time. Chronic sun exposure is the primary risk factor for the development of lentigines, which explains their frequent occurrence in areas exposed to the sun. The increased number of melanocytes leads to an accumulation of pigment in the affected areas, which manifests as dark spots on the skin. While lentigines are typically benign, any lesion that exhibits signs of rapid growth, changes in color, irregular borders, or increased thickness should be biopsied to rule out malignancy, such as melanoma.
Diagnosis
The diagnosis of lentigines is generally clinical, based on the characteristic appearance of the lesions. However, when a lesion demonstrates atypical features, such as asymmetry, irregular borders, color variegation, or significant changes in size and texture, a biopsy may be warranted to exclude other conditions, including skin cancers like melanoma. Dermoscopy, a non-invasive technique that allows detailed examination of the skin, can also be used to differentiate benign lentigines from potentially malignant lesions.
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