Dark Spot Before Laser? Why to Get a Changing Mark Checked First

If a dark or brown mark is new, changing, bleeding, itchy, uneven or simply looks different from your other marks, get it checked by a GP or dermatologist before you consider laser for it. Most sun spots (solar lentigines) are harmless, but some skin cancers can look like them, and a photograph or a cosmetic consultation cannot replace a medical diagnosis. This guide helps you decide what to get checked first and what to ask; it cannot tell you what your mark is.

Why a spot is checked before it is treated

DermNet describes a solar lentigo as a common, benign flat brown mark on sun-exposed skin, but one that can resemble skin cancer. Diagnosis is usually made by examining it, often with dermoscopy (a magnified view), and a biopsy is recommended when the diagnosis is uncertain. Its list of look-alikes includes melanoma in situ, pigmented actinic keratosis and macular seborrhoeic keratosis. DermNet: solar lentigo

The American Academy of Dermatology warns that what looks like an age spot could be skin cancer, and that treating skin cancer as an age spot can give it time to grow. AAD: getting rid of age spots

The Bristol Laser Centre, part of North Bristol NHS Trust, says it is important to check that any brown lesion is benign before laser treatment starts, and advises seeing a GP or dermatologist first. Bristol Laser Centre: age spots

Treating a mark cosmetically also changes it. A spot that has been lasered is harder to compare with how it looked before, so the sensible order is diagnosis first, then any decision about cosmetic treatment.

Marks to get checked first

The NHS advises seeing a GP about a mole that has changed in size, shape or colour, is painful or itchy, or is inflamed, bleeding or crusty. It also advises seeing a GP about a new or unusual mark that has not gone away after a few weeks. NHS: melanoma symptoms

What you notice	What the sources say
A mark that is new, or has changed in size, shape or colour	NHS advises GP assessment; change over time is a warning sign
Uneven shape, irregular edge, or more than one colour	NHS describes these as more typical of melanoma than of a normal mole
Wider than about 6 mm (a guide, not a test)	NHS and CRUK note most melanomas are larger than this, though early ones can be smaller
Bleeding, crusting, soreness, inflammation or itch	NHS advises GP assessment; CRUK notes itch alone can also occur with harmless moles
A mark that looks very different from your others	CRUK advises having it checked
A dark area or line under a nail not caused by injury	NHS and CRUK advise seeing a GP
An unusual mark on a palm or sole that has not gone away	NHS advises seeing a GP

This is a prompt to seek assessment, not a diagnostic checklist. Not every melanoma shows these signs: the British Association of Dermatologists notes that most in situ melanomas have no symptoms at all, so a mark that is simply new or different is reason enough to ask. BAD: melanoma, CRUK: melanoma symptoms

Brown and black skin

Cancer Research UK says melanoma can be harder to spot on black or brown skin. It may not show the usual signs, may look symmetrical, may be pink or broken and sore, and can appear under a nail or on a palm or sole. The BAD notes that when melanoma occurs in richly pigmented skin it often appears on the hands, feet or nails. CRUK: melanoma symptoms, BAD: melanoma

What happens at a medical check

The NHS says a GP who thinks you could have skin cancer refers you to a dermatologist. The specialist examines your skin, asks what has changed, sometimes uses a magnifying device, and may remove the mole and a small area of skin to send to a laboratory. Results usually take about two weeks but can take longer. NHS: tests and next steps

Being referred does not mean you have cancer. If the mark is confirmed to be a harmless sun spot, you then have a clear basis for deciding whether you want it treated cosmetically.

If a spot is confirmed harmless: what to expect from laser

Treatment is optional. DermNet says solar lentigines generally do not need treatment unless for cosmetic reasons, that destructive treatments such as lasers can leave pale or dark marks (temporary or permanent), and that strict sun protection is needed to limit recurrence. DermNet: solar lentigo

The Bristol Laser Centre says two or three treatments may be needed for maximum fading, that sun exposure raises the risk of side effects, and that age spots can return after a few years. It also notes pigment may become paler or darker, and that treatment may not suit very dark skin. These are one service's statements, not a promise for any other clinic or device. Bristol Laser Centre: age spots

Sun spots are a different question from melasma or post-inflammatory pigmentation, which behave differently. If you are unsure which applies to you, read Melasma, Sun Spots or Post-Inflammatory Pigmentation?

Questions to ask before booking pigmentation laser

• How will my mark be assessed before treatment, and by whom?
• Would you want a GP or dermatologist to look at this first? What would make you decline to treat it?
• Is anything about this mark (change, colour, edge, size, location) a reason to be checked before any treatment?
• If the mark were treated, how would its appearance be recorded?
• What are the risks of pale or dark marks for my skin tone, and what sun-protection and aftercare instructions apply to me?
• How many sessions are likely, what is the total cost, and what happens if the mark returns?

Bring: when you first noticed each mark, any change you have seen, any previous check or diagnosis, previous treatment on the area, medicines you take (some increase sun sensitivity) and recent tanning or sunburn. These are conversation prompts, not instructions to treat or avoid anything.

Next step in Bournemouth

If you have a mark you would like to ask about, start with Progen's pigmentation treatment information, then check clinic price information or contact the clinic to ask what appointment is appropriate and how marks are assessed before treatment. If the mark is changing or worries you, see your GP first rather than waiting for a cosmetic appointment. A consultation enquiry does not establish that a mark is suitable for treatment.

Frequently asked questions

Can I have laser on a sun spot without a doctor looking at it first?

That is a question for the treating clinic and your own circumstances. Sources such as the Bristol Laser Centre advise that any brown mark is checked as benign before laser starts, and the AAD warns that treating skin cancer as an age spot can delay diagnosis. If a mark is new or changing, see a GP first.

Is a new brown mark always melanoma?

No. Most brown marks are harmless, and the NHS says change, bleeding, crusting or a mark that has not gone away after a few weeks are reasons to have it assessed. Only an examination can tell you what your mark is.

Does melanoma look different on brown or black skin?

It can. Cancer Research UK says it may not show the usual signs and can appear under a nail or on a palm or sole. If you notice a new or changing mark in these places, see your GP.

Explore Progen's pigmentation treatment information

Sources and further information

• NHS: melanoma symptoms
• NHS: melanoma tests and next steps
• Cancer Research UK: melanoma symptoms
• British Association of Dermatologists: melanoma
• DermNet: solar lentigo
• American Academy of Dermatology: age spots
• North Bristol NHS Trust, Bristol Laser Centre: age spots
• Progen Aesthetics: pigmentation treatment