Age and the evolving landscape

Skin is not static. The dermoscopic appearances you see in a 20-year-old will differ from those in a 70-year-old — and both can be perfectly normal.

Young skin

In children and adolescents, there is less accumulated sun damage and skin turgor is high with vessels less prominent. Melanocytic lesions tend to show a prominent, regular pigment network. Moles in young people often have bold, well-defined networks that would look more concerning in an older adult. This is simply the natural appearance of active melanocytes in young skin. Naevi may still be developing, giving them a dynamic appearance.

Middle adulthood

Sun damage begins accumulating in exposed areas, seborrhoeic keratoses start appearing, naevi stabilise, and early vascular changes may become visible. The pigment network in established moles may begin to show subtle changes as part of normal maturation.

The ageing mole

As people age, many benign moles undergo a natural process of involution — they slowly lose their pigment network, become more raised, and may eventually appear as a skin-coloured bump with no remaining pigment pattern. This gradual fading is entirely normal and is one reason why older adults often report that their moles have "changed" — they have, but as part of a benign natural process.

Older adulthood

Solar lentigines become common on sun-exposed skin. Seborrhoeic keratoses are often numerous — by the time someone reaches their 60s or 70s, they may have dozens. Recognising these quickly (using the features from the earlier section — comedo-like openings, milia-like cysts, fissures) is an essential clinical skill because they are so frequently encountered. Vascular changes become prominent, especially on the lower legs. Cherry angiomas (benign vascular red domes) become increasingly common. Skin atrophy may affect the visibility of some patterns.

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