Melasma vs Sun Spots: How They Differ and Why Assessment Matters

Clinical guidance from Dr Nyla Raja MBChB (Hons), MRCGP (Dist), DFFP, DPDermatology - GMC No. 6057913

Melasma and sun spots can both appear as brown facial pigmentation, but they are not the same condition. Melasma usually causes broader, symmetrical patches influenced by light and hormonal factors, whereas sun spots are individual, well-defined marks associated with cumulative UV exposure. This distinction matters because the most appropriate treatment plan, and the likelihood of recurrence, can be very different.

Before treating pigmentation cosmetically, it is important to establish what type of mark is present. At Dr Nyla Medispa, treatment planning begins with an assessment of the pattern, likely cause, skin type, medical history, recent sun exposure, and previous treatments. Explore our approach to pigmentation treatment for more information.

Melasma vs sun spots at a glance

What is melasma?

Melasma is an acquired pigmentation condition that causes flat areas of discolouration, most often on the central face. It may look brown, dark brown, grey-brown, or more deeply pigmented than the surrounding skin, depending on the individual’s skin tone and the depth of pigment.

Its distribution is often a useful clue. Melasma commonly affects corresponding areas on both sides of the face rather than appearing as one isolated spot. The British Association of Dermatologists notes that the cheeks, forehead, upper lip, nose, and chin are frequent sites.

Ultraviolet exposure is a major trigger, but melasma is not simply sun damage. Pregnancy, hormonal contraception, hormone therapy, family tendency, and some skincare-related irritation can all be relevant. Visible light may also contribute for some people. Melasma can develop in all skin tones and is particularly common in women, although men can be affected too.

Melasma is not harmful or contagious, but it can be persistent. Even after improvement, it may return when triggers remain, which is why a long-term plan and consistent photoprotection are central to management.

What are sun spots?

Sun spots, also called age spots or liver spots, are usually solar lentigines. They are benign, flat areas of increased pigment associated with accumulated UV exposure over time.

Unlike melasma, sun spots tend to be distinct lesions: round, oval, or irregularly shaped marks with a relatively clear edge. They may be light brown, dark brown, or almost black, but an uncomplicated sun spot is usually fairly even in colour. They are common on chronically exposed areas, such as the face, backs of the hands, forearms, shoulders, and chest.

Solar lentigines generally persist throughout the year, although they can darken in summer. They may become more common with age, but can occur earlier in people with significant sun exposure. DermNet describes solar lentigines as benign marks caused by chronic ultraviolet radiation exposure.

Why the diagnosis changes the treatment plan

Well-defined sun spots and diffuse melasma behave differently. A treatment that may be suitable for individual sun-induced marks is not automatically appropriate for hormonally influenced or recurrent pigmentation.

For suitable, assessed sun spots, treatment may focus on the individual lesion and wider signs of photodamage. Depending on the concern, skin type, and clinical findings, options may include light-based treatments, laser treatment, resurfacing, or skincare as part of a personalised plan. Treated sun spots can often become less noticeable, although continued sun exposure may lead to further pigmentation over time.

Melasma requires more caution. Its tendency to recur means treatment generally starts with reducing triggers and supporting the skin barrier, alongside daily broad-spectrum sun protection. Prescription treatment may be appropriate in some cases. Procedures can have a role, but they need careful selection because irritation, inflammation, heat, or unsuitable settings can worsen pigmentation in some patients. The British Association of Dermatologists advises that laser treatment for melasma has variable results and should be undertaken by a highly experienced operator.

For both concerns, daily sun protection is an important part of prevention and management. For melasma, the British Association of Dermatologists advises broad-spectrum SPF 30 or above with high UVA protection, and notes that iron oxides may provide additional visible-light protection. Hats, shade, and avoiding sunbeds are also relevant measures.

What happens during a pigmentation assessment?

An assessment should look beyond the colour of a mark. Useful questions include:

• When did the pigmentation first appear, and has it changed?
• Is it one defined mark, or are there matching patches on both sides of the face?
• Did it start during pregnancy, after a change in hormonal medication, or following a skin injury or acne?
• Has it worsened after holidays, sun exposure, heat, or a previous treatment?
• What skincare, prescription products, and aesthetic treatments have been used?
• Is there any personal or family history of skin cancer?

This information helps distinguish likely melasma and solar lentigines from other causes of pigmentation, including post-inflammatory hyperpigmentation. It also helps determine whether treatment should be conservative, procedural, medical, or deferred pending further assessment.

When a brown mark needs medical assessment first

A mark that is new, changing, or clearly different from your other marks should be medically assessed before cosmetic treatment is considered. Pigmented lesions cannot be safely diagnosed from an online photograph or by colour alone.

The NHS advises GP assessment for a mole or mark that changes in size, shape, or colour, and for marks that become itchy, painful, inflamed, bleeding, or crusted. A new unusual mark that does not settle after a few weeks also deserves assessment. In these situations, medical review takes priority over aesthetic treatment.

The key point

Melasma is usually diffuse, symmetrical, and prone to recurrence because it is influenced by more than sun exposure alone. Sun spots are usually separate, defined marks linked to accumulated UV damage. Both may be improved in suitable circumstances, but the right approach begins with identifying the pattern correctly, excluding concerning lesions, and protecting the skin from further light exposure.