Lasers enable the lightening or removal of pigmented lesions with a low risk of scarring. The most commonly treated conditions are freckles, brown spots, and solar lentigines (“liver spots”) due to aging and sun exposure. We use the Diolite 532 laser or the Nd:YAG laser for treatment of these lesions. Some small pigmented seborrheic keratoses can be removed as well. Other treatment options include cryosurgery with liquid nitrogen, light electrocautery, light curettage (scraping), or topical acid or bleaching agents, which often yield substantial improvement also. We discuss all appropriate treatment options with patients and guide a therapeutic decision to achieve optimal results.