Mole vs. freckle: Understanding the difference between moles and freckles

What’s the difference between a mole and a freckle?

Freckles and moles are different in several ways:

• Moles may be flat or raised, while freckles are flat.
• Freckles are usually brown in colour; moles can be brown, black, pink, the same colour as the surrounding skin, and even blue or grey.
• Moles are genetically determined, and they can grow on any part of the body. They start appearing in childhood, and new ones continue to appear for many years. The rate of new development tends to slow down or stop at about age 40 for most people, but for some, it can continue to appear for their whole life. Exposure to the sun in early life can increase the number of moles, but in general people tend to have as many moles as their parents.
• Freckles appear after sun exposure. They appear most commonly (but not always) on areas of skin that have been exposed to the sun repeatedly over a long period of time.
• Both moles and freckles can be unsightly to some people.

Moles and freckles can be removed with minimal scarring using either radiofrequency surgery or intense pulsed light.

What are moles?

Moles are collections of melanocytes, the cells which produce melanin (skin pigment). Melanocytes are spread throughout normal skin; in a mole they tend to cluster together.

What are freckles?

A freckle, also sometimes known as a lentigo or ephelis, is a patch of normal skin where the melanocytes are producing more melanin than the surrounding area.

People often call freckles “sunspots”, but skin cancer doctors usually use this name for solar keratoses, a potentially pre-cancerous form of sun damage common on exposed areas of skin.

Fair-skinned people often start developing freckles in early childhood.

Larger freckles that appear later in life are sometimes called lentigines, “age spots” or “liver spots”, but they aren’t related to liver function.

Can moles and freckles be cancerous?

Strictly speaking, melanomas and skin cancers are separate from moles. Their structure and behaviour are different—although their appearance is sometimes very similar. To a skin cancer doctor or dermatologist, moles and freckles aren’t “cancerous” by definition. They are normal non-cancer growths or pigmentation of the skin. But people without medical training often think of their skin and moles differently from skin cancer doctors and dermatologists. They might consider any spot or lump to be a “mole”.

This means some of the spots or lumps which patients think of as “moles” are actually skin cancers.

The “moles” which are more likely to actually be skin cancers tend to be “ugly duckling” spots that don’t resemble other moles or freckles elsewhere on the skin. Irregularly-shaped or coloured and growing or changing moles might also be cancers.

Skin tags

Skin tags are harmless soft growths that stick out from the skin. They are extremely common and tend to increase with age.

What are skin tags?

A skin tag is made up of collagen fibres and blood vessels, covered by normal skin. It may be the same colour as or darker than the surrounding skin.

How are skin tags different from moles and freckles?

Skin tags aren’t related to sun exposure on the skin. They are more common in areas where there is friction — and usually little sun exposure— such as armpits, under the breasts, between the upper thighs and around the neck where they may be caused by friction from collars or jewellery.

How are skin tags treated?

Treatment of skin tags is usually performed for cosmetic rather than health purposes. Reasons for treatment include:

• Unsightly skin tags.
• Inflamed, irritated or bleeding skin tags.

Skin tags can be treated using:

• Cryotherapy (freezing).
• Electrosurgery.
• Radiofrequency surgery for minimal scarring.
• Shave or snip excision.

Are moles, freckles, and skin tags signs of melanoma and skin cancer?

Normal moles, freckles, skin tags and lentigines are not skin cancers and they aren’t considered to be pre-cancerous. Moles don’t tend to “turn into” skin cancers.

“Moles don’t tend to “turn into” skin cancers.”

People with many moles (more than 100) have a higher risk of developing melanoma during their lifetime. This doesn’t mean that the pre-existing moles will become melanoma; most melanomas develop in an area of normal skin, where there isn’t a pre-existing mole or freckle.

People with many freckles usually have fair skin. Melanoma, basal cell carcinoma, squamous cell carcinoma and other skin cancers are all more common in fair-skinned people with many freckles.

Australian Skin Cancer Clinical Guidelines recommend that people with many moles or very fair skinned people with many freckles should have a skin cancer check regularly.

Getting moles, freckles, and skin tags treated

Moles, freckles and skin tags should be examined by a doctor to decide the best way of treating them.

Depending on the diagnosis, treatment may be one or a combination of:

• Surgery to cut out the mole completely, usually with stitches to repair the resulting hole in the skin: for moles and other spots that look suspicious for skin cancer
• Punch biopsy or shave biopsy of part of the mole or freckle: to get more information about the diagnosis, allowing better planning for skin cancer treatment or freckle or mole removal
• Radiofrequency surgery for cosmetic removal of moles (usually raised) with minimal scarring
• Broad band light / intense pulsed light to remove freckles
• Cryotherapy (freezing)
• Electrocautery/diathermy (burning)

Making an appointment to have your moles, freckles, and skin tags checked

A skin cancer doctor, nurse or dermatologist can decide whether any given “mole” on the patient’s skin really is a mole, or if it’s likely to be a skin cancer. At Spot Check Clinic, a doctor accredited by the Australasian Skin Cancer College can check your moles for signs of cancer.

• If you are concerned about one or two spots only, and you don’t have skin cancer risk factors, you can usually book an appointment for a 1-3 spot check within 1-2 working days.
• If you would like to have your whole body checked for signs of skin cancer, book a full body skin check.
• If you have many (hundreds) of moles, you may wish to have total body photography (“mole mapping”) to document them all and help track changes.