The Bumps and Spots Nobody Tells You About

What's Normal (and What's Not) on Aging Skin

At some point in your 50s, 60s, or 70s, you're going to look down at your arm, or catch a glimpse of your chest in the mirror, and notice something new. A small dark bump. A cluster of tiny red dots. A soft little flap of skin that definitely wasn't there last year.

And then, if you're anything like most of my patients, you'll quietly panic and wonder if you should be worried.

Here's what I've learned after nearly 45 years of practicing medicine: almost nobody talks about this part of aging skin. Every article you'll find online covers dryness, wrinkles, and sunscreen — and then stops. But the bumps, spots, and marks that show up as we age are just as common, and far more confusing, than dry skin ever was. So let's actually talk about them.

Why Your Skin Changes Shape, Not Just Texture

Before we get to the spots themselves, it helps to understand what's happening underneath. As we age, the boundary between your skin's outer layer and the deeper, blood-vessel-rich layer beneath it gradually flattens out. In younger skin, this boundary is wavy and interlocking, like an accordion, which is part of what gives skin its bounce and resilience. Over time, that wave flattens, your skin thins, and blood supply to the surface decreases.

This is also why you'll notice your skin doesn't "snap back" the way it used to. A quality doctors actually measure and call skin turgor. Pinch the back of your hand: younger skin returns to flat almost instantly. Aging skin holds that tented shape for a moment or two longer. It's not in your head, and it's not a flaw.  It's a measurable, universal part of how skin structurally changes over time.

That same thinning and flattening is also why your skin becomes more prone to the bumps, spots, and marks we're about to walk through.

The Common (and Completely Harmless) Changes

These four show up on the vast majority of people as they age, and almost none of them need to be treated unless you want them gone for comfort or cosmetic reasons:

Seborrheic keratoses are the most common benign skin growth in older adults. Somewhere between half and two-thirds of people over 60 have at least one. They're rough or slightly scaly, ranging from light tan to nearly black, and often look more alarming than they are. They're not contagious and they don't turn into cancer.

Cherry angiomas are small, bright red or purple dome-shaped spots, usually just a few millimeters across. They're caused by a harmless cluster of tiny blood vessels close to the surface, and the majority of people over 75 have several.

Skin tags are those small, soft flaps of skin that tend to show up where skin rubs against skin or clothing. By age 70, more than half of people will have developed at least one. Completely benign.

Senile purpura, the flat purple or dark red patches that seem to appear out of nowhere (especially if you're on aspirin or a blood thinner), happen because the blood vessels under thinning skin have lost their cushioning and tear more easily from very minor bumps. They look alarming and take weeks to fade, but they're a structural skin change, not a sign that something is wrong internally.

What Actually Deserves a Closer Look

This is the part I think is genuinely important to know, because the earlier a true concern is caught, the better the outcome. Most of us were never taught what to actually look for.

Basal cell carcinoma, the most common skin cancer, often looks like a smooth, pearly, or slightly shiny bump, sometimes with tiny visible blood vessels running through it. It tends to grow slowly and rarely spreads, but it can develop into a sore that won't heal.

Squamous cell carcinoma  usually appears as a firm red bump or a rough, scaly, sandpaper-feeling patch.  Sometimes mistaken for a stubborn scab that never quite goes away.

Melanoma is the one to take most seriously, because while it's less common, it can spread if it isn't caught early. The classic warning signs are changes in a mole's symmetry, an irregular border, multiple colors within the same spot, a size larger than a pencil eraser, or any mole that seems to be evolving in size or shape.

None of this is meant to make you anxious about every spot on your body. Most of what shows up as we age is entirely benign. But if something is changing, bleeding, or simply doesn't look like the rest, that's worth an actual appointment, not a Google search at midnight.

Where to Go From Here

Every one of these changes is something I walk through in much more depth in The Aging Skin Matrix, the guide I wrote specifically because I noticed how little of this gets covered anywhere else.

(And if you've ever wondered why aggressive exfoliating acids might be doing your skin more harm than good,  that's a whole other conversation I get into in the guide, too.)

With health and shared experience,
Dr. Soaper