If you look closely at your skin, you may notice darkened spots that are not moles. Freckles are the most common of these spots. Unlike moles, they are rarely larger than the size of a pea, although sometimes they may seem to be because they blend into one another. Sun exposure may make freckles darker or freckles may fade completely in the winter. While moles may appear anywhere on the skin, freckles ordinarily are limited to sun exposed areas, such as the face, neck and upper back. Blondes and redheads freckle most easily.

Multiple small gray-brown spots that may appear on wrists, backs of the hands, forearms, and face could be actinic lentigines. These are also called "liver spots" or "age spots," though they have nothing to do with liver or age. They are sunspots.

Everyone has moles, sometimes 40 or more. Most people think of a mole as a dark brown spot, but moles have a wide range of appearance. Moles can appear anywhere on the skin, alone or in groups. They are usually brown in colour and can be various sizes and shapes. The brown colour is caused by melanocytes, special cells that produce the pigment melanin.

Most moles appear during the first 20 years of a person's life, although some may not appear until later in life. Sun exposure increases the number of moles.

Each mole has its own growth pattern.

• At first, moles are flat and tan, pink, brown or black in colour, like a freckle.
• Over time, they usually enlarge and some develop hairs.
• As the years pass, moles usually change slowly, becoming more raised and lighter in colour.
• Some will not change at all.
• Most moles will slowly disappear, seeming to fade away.
• Others will become raised so far from the skin that they may develop a small "stalk" and eventually fall off or are rubbed off.

This is the typical life cycle of the common mole and since these changes occur slowly the life cycle of the average mole is about 50 years.

Many people have moles removed that are in areas of trauma, where clothing can irritate them, or simply because they are unattractive.

Mole removal is a simple and harmless procedure. The most common methods of removal include numbing the spot and then shaving the mole off, or for some moles, cutting out the entire lesion and stitching the area closed.

The majority of moles and other blemishes are benign (not-cancerous). They will never be a threat to the health of the person who has them. Spots or blemishes that warrant medical concern are those that do something out of the ordinary - those that act differently from other existing moles.

This includes any spot that:

• changes in size, shape or colour, or
• one that bleeds, itches, becomes painful, or
• first appears when a person is past twenty.

A mole displaying any of the above signs should be checked promptly by a doctor. The doctor may be able to assure you that the mole is harmless but it is always best to be safe than sorry. We offer a special skin cancer screening especially for this purpose.

Sebaceous cysts are caused by the accumulation of sebaceous (oily) material resulting from the blockage of a sebaceous duct or gland in the skin. They are fairly common, benign and can occur on or within the labia majora, the back of the neck or on the upper chest and back. Most sebaceous cysts of the vulva grow slowly and remain small.

Symptoms include:

• A (usually) non tender small lump
• A redness, tenderness or increased temperature of skin over area may indicate infection
• A grayish white, cheesy material from the cyst (if one of the cysts is drained or squeezed), which may be malodorous

Sebaceous cysts are usually ignored unless they become bothersome or infected. An infected cyst can form into a very painful abscess. In this case antibiotics may be prescribed, however, surgical incision and drainage is usually necessary for pain relief. Excision of the cyst and the surrounding sac may be necessary to prevent recurrence.

Rough scaly spots on sun-damaged skin are called solar keratoses. They are also known as actinic keratoses. They can give rise to a type of skin cancer called squamous cell carcinoma.

Solar keratoses are mostly found on sites repeatedly exposed to the sun especially the backs of the hands and the face, most often affecting the nose, cheeks, upper lip, temples and forehead. They are especially common in fair-skinned persons or those who have worked outdoors for long periods. Sun-damaged skin is also dry and wrinkled.

Solar keratoses may be prevented by protecting skin from ultraviolet radiation. Sun protection is vital for all fair skinned people working or enjoying themselves outdoors.

Solar keratoses are usually removed because they are unsightly or uncomfortable, or because of the risk that skin cancer may develop in them. If a solar keratosis becomes thickened or ulcerated then it is important to have it checked, as it may have become a skin cancer.

People with a history of previous solar keratoses should have regular visits to the doctor for treatment and to be examined as they are at risk of developing basal cell or squamous cell carcinomas

Treatment of a solar keratosis requires removal of the defective skin cells. New skin then forms from deeper cells that have escaped sun damage. Skin cancers can usually readily be treated if they are detected at an early stage.

Treatments include:

• Curettage & cautery – this method may be preferred with thicker keratoses, or squamous cell cancers. Curettage is the removal of a lesion by scraping it with a sharp instrument. Diathermy, or cautery, burns the keratoses off and prevents bleeding. A scab forms which heals over a few weeks, leaving a small scar.
• Excision - Cutting the lesion out or taking a biopsy, allows for microscopic analysis. This is sometimes important if a lesion may be cancerous. Usually the surgical wound is sutured (stitched). The sutures are removed after a few days, the time depending on the size and location of the lesion.
• 5-Fluorouracil cream (5-FU, Efudix) is most useful when there are many keratoses on the face. The treated areas become red, raw and uncomfortable. Healing starts when the cream is discontinued and the eventual result is usually excellent.
• Imiquimod is an immune response modifier in a cream base and is a promising new treatment for solar keratoses. It is applied for four to sixteen weeks and causes an inflammatory reaction, which is maximal at about three weeks.
• Diclofenac gel - Diclofenac in hyaluran gel has been used successfully to treat solar keratoses.

Warts are caused by a virus that gets into your skin. They are usually skin-coloured and feel rough to the touch but they can also be dark, flat, and smooth.

Two warts that doctors see most often are common warts and plantar (foot) warts.

• Common warts usually grow around your fingernails, on your fingers, and on the backs of your hands.
• People usually find foot warts on the bottoms of their feet. These warts can hurt-they sometimes make you feel like you have a stone in your shoe.

Not everyone gets them. Some people get them because they have been around the virus a lot or are just more likely to catch the wart virus than others, just like some people catch colds more often.

Sometimes common warts go away on their own but because warts can spread to other people or to other parts of your body it is a good idea to have them treated.

It is easier to get a wart virus if your skin is already hurt. This is why children who pick or bite their fingernails are more likely to have them.

If a young child has warts, either the parents or a doctor can paint special mixtures on the warts to help them go away. For adults and older children, the warts can be removed by freezing hem (cryotherapy) or by burning them off under local anaesthetic.

Warts can come back. Sometimes it may seem like new warts start to grow as soon as old ones fade away. This may happen because the old warts spread the virus to the skin around them before they were treated. To keep this from happening it is important to treat new warts as soon as they start so they do not have time to spread.