Birthmark darkening

I am a 30 year old white female and I have an embarassing birthmark above my lip that I've had since I was a child. It has appeared & disappeared over the years, mostly appearing after long sun exposure.  As a child, it would only come out occasionally after sunning, with some freckles on my nose and cheeks.  It disappeared for a few years and returned when I was around 15, after sunning and disappeared in the winter.  I haven't seen it for nearly 10 years (sun or no sun) and then it reappeared when I was 25/26 and it has stayed on my upper lip ever since (looks like a 5:00 shadow but the same brown shade as my freckles...)  I put SPF 30 wax sunblock on my lip anytime I am in the sun, but it does not prevent it from becoming significantly darker.  I started trying over-the-counter skin bleach (Nadinola), but it is so dark, I don't know how long it will take to fade it completely, if at all.  I would like to know if there are any recommendations to fade it naturally or any over-the-counter products I can use, or ideally, if there is a permanent solution, i.e. safe laser removal or prescription medicine.  Could it possibly be changing hormones due to age that are affecting the pigment?  Also, is there anything I should be concerned about, such as skin cancer since this has stayed dark for the past couple of years, sun or no sun?  I appreciate your help.  Thanks!

[Alan Rockoff, MD]

I'm afraid you'll need to see a doctor in person for this one, preferable someone with laser capability.  Having said that, I would add that laser does not sound like the best approach to what I picture you as having.  Perhaps a prescription-strength skin lightening cream might help, or a light chemical peel.  Heavy-duty sun protection against UVA and UVB rays is also recommended to help treatment and prevent further darkening.  But again, for a definitive response, you'll need to have someone examine you.

Best.

Dr. Rockoff