PIGMENTED LESIONS
Lentigines
Lentigines are reviewed in Chapters 109 and 112.
Café-au-Lait Macules
Café-au-lait macules (CALMs) are hyperpigmented macules or patches two to three shades darker than uninvolved skin (see Ch. 112). They are found in at least 10% of the population. CALMs may be evident at birth or, especially in individuals with lightly pigmented skin, become apparent during infancy or early childhood. The presence of multiple CALMs raises the possibility of neurofibromatosis type 1 or another genetic syndrome (see Table 61.3); Fig. 61.10 outlines an approach to a young child with multiple CALMs. A CALM is usually easily distinguished from a fully developed congenital melanocytic nevus, but in infants there may be overlap in the clinical appearance of these two entities. The differential diagnosis also includes the earliest stage of a nevus spilus (before the “speckles” appear), Becker melanosis (nevus) or smooth muscle hamartoma, and a mastocytoma; in addition, segmental CALMs and “pigmentary mosaicism” have significant overlap. Although laser treatment of CALMs is possible (see Ch. 137), responses vary and recurrence of pigmentation is common.