What is the difference between melasma and sun spots?
Sun spots, known medically as solar lentigines, are flat, well-defined brown spots on sun-exposed skin. They reflect cumulative sun damage. Melasma is a symmetrical, patchy brown or grey-brown discolouration, usually on the cheeks, forehead and upper lip, linked to hormones, light and heat.
The two can occur together on the same face. That is one reason a clinical assessment is useful before any plan is made.
Telling them apart is not always straightforward, even for clinicians, which is why assessment under good lighting matters. The sections below explain the usual features of each and why a skin check is the first step.
What do sun spots look like?
Sun spots are usually small, flat and evenly coloured, with a clear edge. They tend to appear on skin that has had the most sun over the years, such as the face, hands, chest and shoulders.
Sun spots may not fade without treatment, and they can darken with further sun exposure.
They are common in Australia, where ultraviolet exposure is high. Most are harmless, but any spot that changes needs to be checked, as the next sections explain.
What does melasma look like?
Melasma tends to form larger patches with softer, less defined edges. The patches are often symmetrical, appearing in similar places on both sides of the face.
It is more common in women and in people with medium to deeper skin tones. Hormonal changes, including pregnancy, are associated with its onset and flares, and both ultraviolet and visible light can stimulate it. Melasma is not harmful, but it can be persistent and may return after it settles.
Melasma is described by the depth of the pigment. Epidermal melasma looks brown with a defined edge, while dermal melasma looks grey-brown or bluish with softer edges. Mixed melasma, a combination of both, is the most common pattern.
Can you tell them apart at home?
A mirror gives some clues, but it cannot give a diagnosis. Other conditions can look similar, and a flat brown mark is not always what it seems.
Marks that follow acne, eczema, injury or a skin procedure can also look similar. These post-inflammatory marks may fade gradually over months with sun protection.
- Edges: sun spots tend to be sharply defined, while melasma edges are softer
- Pattern: sun spots are often scattered, while melasma is usually symmetrical
- Location: melasma favours the cheeks, forehead and upper lip
- Size: sun spots are usually small, while melasma forms broader patches
- Behaviour: melasma often darkens with heat, sun and hormonal change
- History: sun spots build up over years, while melasma can flare within weeks of heat or sun
Why does the difference matter for treatment?
Heat and inflammation can stimulate pigment production in melasma-prone skin. Some energy-based treatments that suit sun spots can therefore make melasma more active.
Sun spots are a localised result of past sun damage, while melasma is a long-term condition that is managed rather than cured. Matching the approach to the type of pigment is the main reason for getting the diagnosis right first, before any treatment is chosen.
Misidentifying melasma can mean months of treatment that does not help or that worsens the pigment. Misidentifying a spot is more serious, because a skin cancer could be missed.
Why does a skin check come first in Australia?
Australia has among the highest rates of skin cancer in the world. Some early skin cancers can look like a harmless flat brown spot, and treating one as pigmentation could delay the right diagnosis.
For that reason, any spot that is new or changing should be checked before pigmentation treatment is considered. If a spot looks concerning, Dr Marie-Claire refers you for a skin cancer check or biopsy first.
A skin check can be done by your GP or at a skin cancer clinic. Regular checks are sensible if you have had significant sun exposure.
Which spots should be seen by a doctor first?
Have a spot checked promptly if it has any of the following features. This list is a guide and not complete, and any spot that worries you deserves a check.
- It is new, or has changed in size, shape or colour
- It has an irregular border or uneven colour within it
- It is raised, itchy, crusted or bleeding
- It looks different from your other spots
- It does not heal
What treatment options may be considered?
Daily broad-spectrum sun protection, protective clothing and a gentle routine are the foundation of care for every type of pigmentation. For melasma, avoiding irritation and heat also matters.
Energy-based treatments such as laser may be considered for some sun spots once they are confirmed as harmless. For melasma, they are used only after careful assessment, because they are not suitable for everyone. Gentle chemical peels may be considered in selected cases, and prescription topical treatments, where appropriate, are discussed in consultation.
Timing matters as well. Treatment is usually planned around the season and recent sun exposure, because tanned or sun-exposed skin is more prone to pigment change.
Pigment can return, particularly with melasma. A hat, daily sunscreen and avoiding peak sun remain part of care after any treatment.
How does Dr Marie-Claire approach pigmentation?
Assessment comes first. At a consultation in St Kilda, Dr Marie-Claire examines your skin, asks about sun exposure, hormones, medicines and skin history, and decides whether a spot needs a skin check before anything else.
If a spot needs a skin check, that step is arranged before any pigmentation plan begins.
She then explains which approaches may be considered, with the risks and alternatives, in a written plan. Individual results vary, and pigment can return, which is why sun protection stays central.
Some people are advised to begin with skin health alone. Treatment is planned only after assessment.
