Snapshot An 8-year-old girl is embarrassed because she has dark spots all along her cheeks and arms. She spends a lot of time playing in the sun and thinks that the spots are darker after sun exposure. At her annual exam, her pediatrician assures her that her dark spots are harmless. Introduction Common, benign small brown macule that darkens with sunlight Genetics autosomal dominant inheritance pattern Epidemiology common in light-skinned individuals Pathogenesis normal number of melanocytes with ↑ melanin pigment Also known as “freckles” Presentation Symptoms darkens with sun exposure lightens without sun exposure Physical exam sharply defined brown macules limited to face, arms, upper trunk Evaluation Diagnosis by clinical exam and history Differential Flat seborrheic keratosis Pigmented actinic keratosis Treatment Sunscreen use and avoid sun exposure Prognosis, Prevention, and Complications Prognosis most will fade by winter time Prevention sunscreen use and avoid sun exposure