Freckles (ephelides)

They are well defined, 1-2 mm in diameter and uniform in color. The color of freckles varies from red or tan to light brown. The number of freckles can range from a few rare spots on the nose and cheeks to hundreds. They are typically localized to the skin of the face, hands, and upper trunk.

Juvenile Lentigo (Lentigo Simplex)

They are round or oval spots 2-10 mm in diameter. They are usually darker than freckles and have a uniform color that resembles tan, brown, or black. Their color is consistent, although the pigmentation may have a lacy or granular pattern. A drop of mineral oil applied to the spot reduces surface shine and helps to assess the type of pigmentation.

Solar Lentigo

Large oval or geometric spots ranging in size from 2 to 20 mm. The color is often uniform, although the pigmentation may appear granular. Multiple lentigines resemble ink spots, although their borders are clearly defined. Signs of actinic damage are visible on the surrounding skin. Solar lentigo appears on sun-exposed areas of the face, hands, dorsal side of the hands, and upper trunk after sun exposure or many years of sun exposure. The number and size of these flat brown spots increase over time.

Labial Melanotic Macule

These brown spots on the red border of the lower lip have a smooth border and are benign.

Penile Lentiginosis

Often one, occasionally several brown spots on the shaft, glans, and foreskin of the penis.

Vulvar Lentigo (Vulvar Melanosis)

Often one, occasionally several brown, dark brown, and/or black spots on the labia majora and labia minora.

Nail Lentigo

Nail appears with stripes (longitudinal melanonychia).

Reticulate Black Solar Lentigo (Ink-Spot Lentigo)

Appears as a dark brown or black, often solitary spot with noticeably irregular borders. It has a reticulated structure and resembles an "ink spot" on the skin.

Atypical Solar Lentigo

Appears as a large solitary spot with irregular shape, with multicolored (ranging from tan to black) pigmentation and irregular structure. Unlike regular solar lentigo, atypical lentigo has areas of melanocyte spread.

Multiple Lentigines (Lentiginosis)

Characterized by multiple eruptions not associated with systemic disorders, but may be a sign of an autosomal dominant syndrome.

PUVA-Induced Lentigines

Develop in 1.5-4% of patients undergoing UVA therapy. They are typically generalized dark brown spots, including palms and soles, resulting from melanocyte hypertrophy and hyperplasia.

Peutz-Jeghers Syndrome

It is associated with intestinal polyposis and involves multiple lentigines on the oral mucosa.

LEOPARD Syndrome (Noonan syndrome with multiple lentigines)

Includes: Lentigines - multiple lentigines; Electrocardiogram abnormalities - EKG deviations; Ocular disorders - eye pathology; Pulmonary stenosis - narrowing of the pulmonary artery; Abnormalities of genitalia - genital pathology; Retardation of growth - growth delay; Deafness - hearing impairment.

Carney Complex

Known by the acronym LAMB or NAME. This syndrome consists of lentigines, atrial and/or mucocutaneous myxomas, myxoid neurofibromas, freckles, and blue nevi.

Cronkhite-Canada Syndrome

Lentigines on the mucous membrane of the cheeks, face, palms, and soles, along with alopecia, onychodystrophy, and intestinal polyps.

Laugier-Hunziker Syndrome

Characterized by dark brown spots up to 4-5 mm in diameter, mostly on the mucous membrane, sometimes extending to the red border of the lips. In some patients, these elements are found on the genitals. Nail changes in form of melanonychia are observed in 2/3 of cases.

Cantu Syndrome

Cantu Syndrome (Hyperkeratosis-Hyperpigmentation Syndrome) characterized by small areas of hyperpigmentation primarily resulting from sun exposure, as well as pinpoint papular hyperkeratosis on the palms and soles.

Bannayan-Riley-Ruvalcaba Syndrome

Characterized by multiple malformations: macrocephaly, multiple lipomas, intestinal polyps, vascular malformations, and abnormal skin pigmentation on the penis.

Centrofacial Lentiginosis

Centrofacial Lentiginosis (Touraine Syndrome) - lentigines in the central part of the face: forehead, nose, occasionally on the lips and neck. Mucous membranes are not affected. It is associated with dysraphic status (gothic palate, cranial deformity, lack of incisors, sunken chest, spina bifida), neuro-psychiatric disorders (intellectual disability, epileptiform seizures, enuresis), and congenital hypertrichosis.

Diagnosis is usually based on clinical presentation, history, and dermoscopy.

• Seborrheic keratosis
• Pigmented actinic keratosis
• Lentigo Maligna
• Melanoma
• In case of multiple lentigines, an associated syndrome can be suspected, such as Peutz-Jeghers syndrome, LEOPARD syndrome, or NAME syndrome (LAMB).
• Café-au-lait spots
• Melanocytic nevus
• Melasma

• Freckles do not require treatment and fade during the winter months.
• Sunscreens prevent the appearance of new freckles and their seasonal darkening.
• Juvenile lentigo also does not require treatment.
• Prevention of solar lentigo is best achieved through sun protection measures, such as avoiding sun exposure, wearing hats, protective clothing, and using sunscreen.
• Hydroquinone solutions, tretinoin, azelaic acid creams, and glycolic acid peels reduce hyperpigmentation over weeks and months.
• Superficial cryosurgery shows the effectiveness