Dermatologists answer the top 5 questions about liver spots

Liver spots are harmless though unsightly to some patients. (Photo courtesy of American Academy of Dermatology)

Liver spots are harmless though unsightly to some patients. (Photo courtesy of American Academy of Dermatology)

Liver spots, black-brown splotches that tend to arise with age and sun exposure, have nothing to do with the liver or liver problems. But experts say it’s worth seeing a primary care provider or dermatologist to confirm proper diagnosis and treatment. Actual liver spots pose no harm, but some patients find them unsightly, and they may indicate unhealthy levels of sun exposure. “Worst case scenario, it could be melanoma,” says Dr. Rebecca Kazin, a highly rated dermatologist at The Johns Hopkins Dermatology and Cosmetic Center at Green Spring Station in Lutherville, Md. To gauge risk, ask your provider these questions:

1. What are liver spots?

Don’t self-diagnose. What you call a liver spot could in fact be a benign wart-like growth called seborrheic keratosis, an atypical mole or a premalignant lesion, says Dr. April Armstrong, director of the dermatology clinical research unit at highly rated UC Davis in Sacramento. “If it’s not [a liver spot] it goes to a totally different decision tree,” says Armstrong, such as biopsying suspected cancer. Liver spots confirmed? Next question.

2. Should I treat it?

Once Armstrong explains liver spots aren’t harmful, she says many patients opt not to undergo treatment, but others seek to erase spots from their face and hands to preserve a more youthful appearance. She says it’s really up to the patient to decide based on whether they want a cosmetic procedure, along with costs and adverse effects associated with treatment.

3. What are my primary treatment options and the risks?

“You can start as conservative as lightening creams,” Kazin says. “We do chemical peels and we do laser.” Laser tends to be the most effective, doctors say, but along with chemical peels it can lead to a change in pigmentation in spots or scarring in some cases. Peels, which take away layers of skin, can cause temporary redness, and side effects increase with deeper peels. Topical creams lighten spots, and cause little adverse effects, but can take months to show results.

4. Who should administer the treatment?

It could be a doctor, nurse or esthetician, depending on laws in your state. Armstrong says to look for a high level of experience and ask about credentials and training upfront.

5. How much will it cost?

Health insurers typically cover dermatology visits to check out spots, often with a copay or other cost-sharing. However, because treatment for liver spots is purely cosmetic, it typically isn’t covered. Armstrong says costs vary widely, but a small tube of prescribed lightening cream that may last several months costs around $100. Chemical peels cost $100 to $500 per treatment and often require two to five visits, with fewer visits for costlier, deeper peels. Laser treatments, often the most expensive option, can cost several hundred dollars or more, but treatment may be completed in one to two visits.

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