Brown spots on the skin can be caused by a variety of factors including aging, exposure to sunlight, inflammation, skin pigmentation disorders, genetics, medications, and hormonal changes. Seborrheic keratosis is a common noncancerous skin growth that usually appears as brown or black, waxy, scaly, and slightly raised lesions. They appear on the face, neck, chest, or back, and tend to occur more frequently with age. Age spots, also known as liver spots or solar lentigines (lentigo), are caused by overactive pigment cells that produce melanin in high concentrations when exposed to ultraviolet (UV) light over time in genetically susceptible individuals. Age spots can appear anywhere on the body, particularly on areas that are frequently exposed to the sun, such as the hands, face, and arms. Melasma, on the other hand, appears as light or dark brown patches or freckle-like spots on the face, particularly on the cheeks, nose, forehead, and upper lip, often confluent as large patches, and is caused by hormonal changes during pregnancy, menopause, or the use of birth control pills, as well as sun exposure in people where genetically melasma runs in the family. Inflammation resulting from eczema, psoriasis, injury to the skin, or acne can also lead to the development of dark spots on the skin. This is called post-inflammatory hyperpigmentation (PIH) or post-inflammatory pigment alteration (PIPA) and is more commonly seen in darker skin individuals. Additionally, certain medications, such as chemotherapy drugs and antimalarial medications, some antidepressants as well as some antibiotics (minocycline, doxycycline) can cause hyperpigmentation or dark spots on the skin. Birthmarks and skin cancer can also cause skin discoloration in terms of brown spots or dark spots. While most brown spots are harmless, changes in size, shape, color, or texture of any skin spot or mole could indicate skin cancer and should be examined by a dermatologist. Treatment options for brown spots on the skin depends on the specific diagnosis which should be made by a board certified dermatologist as it has implications for choosing the proper treatment. These include topical medications, such as hydroquinone, retinoids, corticosteroids, vitamin C to name a few. There are oral medications such as tranexamic acid that have been shown to be very useful for the treatment of dark spots in melasma. Chemical peels, microdermabrasion, laser therapy, and hydrafacials are other useful treatment modalities. Cryotherapy is a risky treatment for brown spots as it can leave permanent white spots on the skin. The most effective way to prevent brown spots on the skin is to protect the skin from sun exposure by wearing protective clothing, using sunscreen with SPF of 30 or higher, seeking shade during peak sun hours, and avoiding tanning beds.