Dark spots on skin are one of the most common concerns patients bring to a dermatologist at the end of summer. A patch on the cheek that was not there in May. A cluster of brown marks across the back of the hands. A streak of discoloration on the forehead that appeared gradually and has no intention of fading on its own. These marks go by different names depending on the cause, including sun spots, age spots, melasma, and post-inflammatory hyperpigmentation, but they all share one thing in common: they change the way your skin looks, and that change can be concerning.
The question most patients ask is straightforward: is this something I should worry about? The answer depends entirely on what is causing the discoloration. Some dark spots on skin are purely cosmetic. Others are warning signs of sun damage that could progress. A board-certified dermatologist can tell the difference in a single visit, and that distinction matters more than any over-the-counter product ever will.
What Causes Dark Spots on Skin?
Dark spots form when the skin produces excess melanin, the pigment that gives skin its color. This overproduction can be triggered by several different factors, and understanding the cause is the first step toward effective treatment.
Sun exposure is the most common trigger. Ultraviolet radiation stimulates melanocytes, the cells that produce melanin, to ramp up production as a defense mechanism against UV damage. Over time, this leads to concentrated deposits of pigment in areas that get the most sun: the face, hands, forearms, chest, and shoulders. These marks are often called solar lentigines, or more commonly, sun spots or age spots. They tend to appear after age 40 but can show up earlier in people with significant cumulative sun exposure. After a full summer of outdoor activity, whether on the lake, at the golf course, or just spending time in the yard, these spots become noticeably darker and more visible.
Melasma is a different type of hyperpigmentation that produces larger, blotchy patches of brown or grayish-brown discoloration, usually on the cheeks, forehead, bridge of the nose, and upper lip. It is driven primarily by hormonal changes and is significantly worsened by sun exposure. Women are affected far more often than men, and pregnancy, oral contraceptives, and hormone replacement therapy are common triggers. Melasma is sometimes called the mask of pregnancy because of how frequently it develops during that time. The summer months make melasma visibly worse because UV exposure intensifies the pigmentation, even with sunscreen use.
Post-inflammatory hyperpigmentation, or PIH, occurs when the skin darkens in an area where there was a previous injury or inflammation. Acne lesions, bug bites, cuts, burns, eczema flares, and even aggressive skin treatments can leave behind dark marks as the skin heals. PIH is more common and more noticeable in patients with darker skin tones. It is not a scar in the structural sense, but it can take months to fade without treatment.
When Dark Spots on Skin Could Be Something More Serious
Most dark spots on skin are benign, but not all of them. This is the part that makes a professional evaluation worth the visit. A spot that looks like a harmless sun spot to an untrained eye can sometimes be an actinic keratosis, a precancerous lesion caused by cumulative UV damage. In rarer cases, a dark spot could be lentigo maligna, a type of melanoma that appears on chronically sun-damaged skin and can closely mimic a benign sun spot in its early stages.
The signs that should prompt a visit to a dermatologist include any dark spot that is new and growing, a spot with irregular borders or multiple colors within it, a mark that bleeds, itches, or crusts, or a patch that looks different from the other spots on your skin. The ABCDE criteria used for evaluating moles also apply here: asymmetry, border irregularity, color variation, diameter greater than six millimeters, and evolution over time. If any of these features are present, a dermatologist should evaluate the spot promptly.
Dermatologists use dermatoscopy, a magnified examination with polarized light, to evaluate suspicious spots with a level of detail that is not possible with the naked eye. If a biopsy is warranted, it can be performed the same day, and results are typically available within one to two weeks.
How a Dermatologist Treats Dark Spots on Skin

Treatment depends on the type, depth, and cause of the pigmentation. There is no single product or procedure that works for every kind of dark spot, which is why a professional diagnosis is the necessary first step.
For sun spots and solar lentigines, cryotherapy with liquid nitrogen is a common and effective office-based treatment. The liquid nitrogen freezes the excess pigment, and the treated spot darkens, crusts, and peels away over one to two weeks, revealing more evenly toned skin underneath. For patients with widespread sun damage across a larger area, prescription topical treatments such as hydroquinone, tretinoin, or a combination formulation can be applied at home over several weeks to gradually lighten the discolored skin.
Melasma requires a different and more careful approach because it is driven by internal factors like hormones as well as external triggers like UV exposure. First-line treatment typically involves a combination of topical agents: hydroquinone to suppress melanin production, a retinoid to increase cell turnover, and a mild corticosteroid to reduce inflammation. This triple combination therapy has strong clinical evidence behind it. Strict and consistent sun protection is essential for melasma patients because even brief unprotected sun exposure can undo weeks of treatment progress.
Post-inflammatory hyperpigmentation often improves on its own over time, but that timeline can stretch to six months or longer without intervention. Topical treatments containing ingredients like hydroquinone, azelaic acid, vitamin C, or niacinamide can accelerate fading. Addressing the underlying cause of the inflammation, whether that is acne, eczema, or another condition, is equally important to prevent new marks from forming as old ones fade.
What Over-the-Counter Products Can and Cannot Do
Drugstore brightening products work for some patients with mild, superficial discoloration. Products containing vitamin C, niacinamide, alpha hydroxy acids, or licorice root extract can produce gradual improvement when used consistently over several weeks. These are reasonable options for patients with minor unevenness who want to try something before seeing a dermatologist.
What over-the-counter products cannot do is diagnose what is causing the dark spots on skin. A spot that is actually an actinic keratosis will not respond to a brightening serum and needs medical treatment. A patch of melasma requires a targeted prescription approach that addresses the hormonal component. Using the wrong product on the wrong type of discoloration can sometimes make things worse, particularly products that irritate the skin and trigger more inflammation, which leads to more post-inflammatory hyperpigmentation in a frustrating cycle.
If you have tried over-the-counter products for six to eight weeks without noticeable improvement, or if you are not sure what kind of dark spots you have, a dermatologist can clarify the diagnosis and recommend a treatment that actually matches the problem.
The Role of Sun Protection in Preventing Dark Spots on Skin

Every type of hyperpigmentation is made worse by UV exposure, which means sun protection is both prevention and treatment. Broad-spectrum sunscreen with SPF 30 or higher, applied daily to all exposed skin and reapplied every two hours when outdoors, is the single most important thing a patient with dark spots on skin can do. This applies year-round, not just during the summer months.
For patients actively treating hyperpigmentation, sun protection is non-negotiable. Prescription lightening agents will not produce lasting results if the skin continues to be exposed to UV radiation without adequate protection. Dermatologists recommend mineral sunscreens containing zinc oxide or titanium dioxide for patients with melasma because these physical blockers provide immediate, broad-spectrum coverage without the irritation that some chemical filters can cause.

Wide-brimmed hats, UV-protective sunglasses, and seeking shade during peak UV hours between 10 a.m. and 4 p.m. add meaningful layers of defense. In Southeast Tennessee, where outdoor activity runs well into October, maintaining sun protection habits through the fall is just as important as the summer routine.
Schedule an Appointment
If you have dark spots that appeared or worsened this summer, a professional evaluation takes the guesswork out of what you are dealing with and what will actually work to treat it. The board-certified dermatologists at Chattanooga Skin and Cancer Clinic have been serving patients across the Tennessee Valley since 1973. Our Cleveland office is located at 3891 Adkisson Drive, Cleveland, TN 37312, and is open Monday through Friday, 7:30 a.m. to 4:30 p.m. EST. Visit our contact page to request an appointment or call 423-479-8648 to schedule.
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