White spots on the skin are rarely due to skin cancer. However, any white mole or spot that does not heal, appears unusual, or changes in appearance (shape, size, or color) should be examined by a doctor.
White spots on the skin are areas of discoloration that can be either raised (white bumps) or flat patches. These can occur due to several reasons, such as sun damage, autoimmune processes, infections, and rarely, due to cancerous lesions.
In this post, we will specifically discuss whether white spots on the skin can be cancer. Additionally, you will find pictures and information about some of the common non-cancerous white spots on the skin.
Overview
The majority of white spots on the skin are not cancerous. However, on rare occasions, certain types of skin cancer and precancerous lesions, such as actinic keratosis, can present as white spots on the skin.
Skin cancers are of various types and can present in different ways. The three main types are squamous cell carcinoma, basal cell carcinoma, and melanoma.
Other less common types include cutaneous or skin lymphoma, sebaceous carcinoma, and Merkel cell carcinoma, among others.
Cancerous white spots on the skin
Below, we will discuss a few types of cancerous white spots on the skin that may present as flat patches or as raised spots.
1. Actinic Keratosis
Actinic keratosis is a precancerous lesion, which means if left untreated, in some people, it can progress to squamous cell carcinoma, a type of skin cancer.
Actinic keratosis commonly appears in areas exposed to the sun such as the face, scalp, hands, neck, and so on. UV rays can damage the DNA in our skin cells leading to actinic keratosis.
Actinic keratosis can present as a white, pale, skin-colored, pink, red, or tan spot. Often these spots have a rough, crusty surface.
Actinic keratosis can be treated with topical agents such as 5-fluorouracil, freezing treatment, and surgical procedures like curettage and desiccation.
2. Basal cell carcinoma
Basal cell carcinoma is the most common type of skin cancer and can present in various ways, including:
- A shiny or waxy bump that is white, skin-colored, pink, red, tan, or brown.
- A white scar-like area or patch.
- A flat, scaly patch.
- A pink growth with rolled edges and a central indentation.
- A non-healing sore or ulcer.
This cancer occurs due to exposure of our skin to UV rays, which results in DNA damage to the basal cells of the epidermis. The epidermis is the top layer of skin, composed of five layers, with the basal cells located at the bottom.
This tumor grows slowly, so if detected and treated early, it can give very good results. The treatment will depend on several factors such as the type, size, and location of the tumor.
3. Amelanotic melanoma
Amelanotic melanoma is a rare variant of melanoma in which the tumor cells lack pigment. A typical melanoma usually appears as a dark-pigmented lesion, while amelanotic melanoma may appear as a white, pale, skin-colored, red, or pink spot on the skin.
The unusual white appearance of these melanomas may cause them to go unnoticed, often resulting in a late diagnosis.
The exact cause of melanoma is not known, although genetics and UV rays may play a role in its development.
The treatment for amelanotic melanoma depends on its size, depth of invasion, and whether it has spread to other parts of the body. Usually, these tumors are treated surgically with a wide local excision of the lesion. Other treatment options may include radiotherapy, chemotherapy, or targeted therapy.
4. Hypopigmented mycosis fungoides
The name sounds complex, but in simple terms, mycosis fungoides is a type of skin lymphoma, which is a form of cancer. In this condition, lymphocytes (a type of our blood cells) become cancerous and affect our skin.
It usually presents as a red rash. However, it can also appear as hypopigmented pale or white areas, referred to as hypopigmented mycosis fungoides.
The lesions typically appear in areas not exposed to the sun, such as the trunk, buttocks, and extremities (bathing suit pattern). Treatment may include phototherapy along with topical medications. However, keep in mind that this condition is quite uncommon or rare.
Non-cancerous white spots on the skin
Most white spots on the skin are non-cancerous or benign. Below are a few common examples with pictures.
- Vitiligo: Vitiligo presents as smooth white patches due to the loss of pigment in the skin. It usually starts as a small white spot which may enlarge over time. The exact cause of it is not clear; however, the immune system and genetics may play a role.
- Tinea versicolor: Tinea versicolor can present with white, brown, or pink spots. It is a fungal infection that occurs due to an overgrowth of the Malassezia fungus. These white patches are usually seen on the trunk, neck, and arms and may become more prominent after sun exposure.
- Pityriasis alba: This is a type of eczema that may lead to dry round or oval white patches on the skin. These white patches are commonly seen in children and young adults. It often coexists with atopic dermatitis.
- Milia: Milia are hard white bumps commonly seen on cheeks and near the eyes. They occur due to trapped dead skin cells under the skin. Factors that may contribute to their development include skin damage, sun exposure, occlusive skincare products, hormonal changes, or certain procedures.
- Idiopathic guttate hypomelanosis: Also known as white sun spots, these appear as flat white spots on sun-exposed areas. They are commonly seen in people over the age of 40 years. Genetics and sun exposure may play a role in their development.
How to identify a cancerous mole or spot on your skin?
Skin cancer can present in many different ways, but there are some general signs and symptoms to look out for. It’s always important to consult with a healthcare professional if you have any suspicious or unusual skin moles or spots. Additionally, you should always get annual skin examinations.
ABCDE rule
The ABCDE rule may help you identify things to look for. However, while this rule is most helpful for melanomas, it may not be as helpful for identifying non-melanoma skin cancers or certain variants of melanoma such as amelanotic melanoma.
- A for Asymmetry: This refers to the shape of the mole or skin lesion. If a line is drawn in the middle, a normal mole will have similar halves. If a mole is asymmetrical, it could be a sign of skin cancer.
- B for Border: The borders or edges of a benign or normal mole are usually smooth. Therefore, any mole with ill-defined or irregular borders should be evaluated.
- C for Color: A normal mole usually presents with a single, uniform color. If you see a mole with different shades of color – from brown to black, or even red, blue, or white – this could be a warning sign.
- D for Diameter: Any skin lesion or mole that is larger than the size of a pencil eraser, about 1/4 inch or 6 mm, should be examined by a doctor. However, do note that skin cancers can be smaller than this in the initial stages.
- E for Evolving: Evolving refers to any changes in the mole or spot over time, whether in size, shape, color, elevation, or other features. The presence of new symptoms like bleeding, itching, or crusting also falls under this category. Any change in a mole or skin lesion over time is significant and should be evaluated by a doctor.
If you have multiple moles and all look the same except one, then that needs to be evaluated.
In addition, some cancerous skin spots may present with the following features:
- A sore that does not heal.
- A bump that is shiny or waxy.
- A flat red spot that is rough, dry, or scaly.
- Firm, red nodules.
It’s also important to be aware that not all unusual changes indicate cancer. So, not every suspicious spot is cancer. But it is always best to see a doctor if you notice any unusual spots on your skin.
Skin cancers, like melanoma, when detected and treated early, can have good outcomes. This early intervention can also prevent the spread of cancer cells in the body.
Sun protection
While we may not have control over certain factors, we can definitely take steps to protect our skin, especially from sun exposure.
- Always wear a broad-spectrum sunscreen with an SPF of at least 30.
- Use sun-protective clothing, hats, and sunglasses.
- Seek shade whenever possible.
- Avoid sun exposure from 11 a.m. to 3 p.m., when the sun’s rays are strongest.
- Steer clear of tanning beds.
- If you notice any unusual skin lesions, be sure to have them checked by your doctor.
Summary
White spots on the skin are usually harmless. However, in very rare cases, they can be due to cancer. The common causes of white spots on the skin include idiopathic guttate hypomelanosis, milia, pityriasis alba, vitiligo, and tinea versicolor.
If you have a suspicious white mole or spot, it’s always best to consult a doctor for a proper examination, diagnosis, and treatment.
Read more:
References
- Basal Cell Carcinoma. Skin Cancer Foundation.
- Basal Cell Carcinoma Warning signs. Skin Cancer Foundation.
- Furlan FC, Sanches JA. Hypopigmented mycosis fungoides: a review of its clinical features and pathophysiology. An Bras Dermatol. 2013 Nov-Dec;88(6):954-60. doi: 10.1590/abd1806-4841.20132336. PMID: 24474105; PMCID: PMC3900347.
- Gameiro A, Gouveia M, Tellechea Ó, Moreno A. Childhood hypopigmented mycosis fungoides: a commonly delayed diagnosis. BMJ Case Rep. 2014 Dec 23;2014:bcr2014208306. doi: 10.1136/bcr-2014-208306. PMID: 25538219; PMCID: PMC4275721.
- Patraquim C, Gomes MM, Garcez C, Leite F, Oliva T, Santos A, Pinto A. Childhood Hypopigmented Mycosis Fungoides: A Rare Diagnosis. Case Rep Pediatr. 2016;2016:8564389. doi: 10.1155/2016/8564389. Epub 2016 Nov 29. PMID: 28025633; PMCID: PMC5153468.
- Mycosis fungoides. National Organization for Rare Disorders.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.