If you are concerned about abnormal spots on your scrotum, I recommend seeing your primary care doctor
or a healthcare professional for formal evaluation. There are many causes for skin color changes, some benign and others more serious. A common cause of dark pigmented spots on the skin are freckles, which are clusters of melanin deposition by melanocytes. They are flat and appear in continuity with the skin. Freckles can develop a more sinister presentation as moles, which are larger clusters of melanocytes that may involve different skin layers. In order to have a darkened appearance, they must be present in the epidermis, which is visible from the surface. Moles can be raised, and have an increased risk of developing into malignancy. Melanoma is a pigmented skin cancer that can occur anywhere in the body, and has several common abnormal appearances. Melanoma lesions are often asymmetric, with abnormal appearing borders. They have color variation, e.g. areas of dark and lighter regions, and they often have larger diameters. Finally, a lesion is more likely to be concerning for melanoma if it is changing or evolving over time. Generally, stable, small dark clusters of non-raised skin pigmentation is consistent with freckles. However, formal evaluation by a doctor will allow for a diagnosis.