Is this cafe au lait? Can I have it surgically removed? (photo)

Question

I have a weird spot on my back that appeared there when I was 8 (I'm 36 now). Can anyone tell me what it's type is? It looks like part cafe au lait, but with dark spots. It's about an inch and a half across. I've had bad luck with laser on a different type, actual birthmark on my leg, so I'd like to know if excision is a reasonable treatment, or is it too big to excise? I would prefer a scar to the spot, and it's on my back, so I don't have to worry about hiding during recovery.

Hooman Khorasani, MD · Answer

Great picture! it is really helpful to evaluate the lesion with the picture.  One thing is that this should be evaluated by a dermatologist to make sure it is not anything more than a birthmark or cafe au lait macule.  If you desire the whole thing removed and do not mind trading it for a line scar than removal by surgery is the best option.  If you want to try less invasive options you can consider lasers (such as Alexandrite) that if does not work can always have the area surgically removed. I recommend that you see a board certified dermatologist to evaluate the spot and possibly remove the lesion by excision if you prefer to go that route.  Wish you all the best.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Harold J. Kaplan, MD · Answer

Hi Melanie. This spot looks like a speckled nevi and not a cafe au lait.  Speckled nevi are treatable with lasers, but are much more resistant to removal than cafe au lait birthmarks are.  In some cases we have been able to get rid of them with q-switched lasers and in some cases we have not.  We have also used fractional lasers with smaller areas like this with success.  If you do proceed with surgery, you will need to prepare for trading the birthmark for a scar.  
To see an example of another very resistant birthmark that we treated with fractional technology, click on the link below.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Yes, surgery is the best option. There are two components to this birth mark- the CALM component and the naevi or moles. The CALM can respond to laser, the moles usually do not. For lesions like these, I prefer to surgically excise the lesion as it will be gone for good without recurrence. Dr Davin Lim.

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