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Q. One of my twin girls has big hyperpigmented spots on legs and arms. Could this be Cafe Au Lait?

Answered by
Dr. Snehal Laul
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Oct 14, 2020

Hello doctor,

We have identical twin girls who are six years old. Both have hyperpigmented spots, but one of them has more than the other and a bit larger. They are tan, a little indistinct, and several with ragged edges. We have been able to identify seven spots. It appears they have darkened as we have not noticed several of them in prior years. Their pediatrician has never said anything regarding the spots.

I have attached the pictures and circled the areas. These are specified on her legs and arms. None are located on her trunk, face, neck, or buttocks. I also included a family picture, showing the differences in our pigmentation.

Now that we have noticed these, my partner and I are very concerned that these could be a sign of NF1. She does not have any freckling spots in her inguinal, neck, or axillary areas. The only freckles she has are on her cheeks and nose, like her sister.

The girls have their annual check-up next week, and we have set a subsequent dermatologist appointment for next month, to be sure. The girls did have their first eye doctor appointment several months ago, and the optometrist stated everything looked great.

Could the hyperpigmentation be due to our contrasting pigmentation? I am a redhead myself, and my wife has a much darker complexion. I have a couple of hyperpigmented ragged spots on my leg, as well, but none as large as hers. Do these spots concern you for further evaluation of NF1 and Cafe Au Lait.

#

Hello,

Welcome to icliniq.com.

It is a prototypical benign melanocytic nevus, which is acquired nevus due to excess sun exposure. It is a benign growth on the skin, usually tan, brown color that contains a cluster of melanocytes. It may disappear with advancing age.

Avoid long term sun exposure. Severe sunburn at early age, being fair skin are risk factors leading to melanoma in later life. Avoid repeated exposure to radiation or UV radiation. Avoid frequent exposure to certain chemicals. Avoid midday sun. Use sunscreen lotion even on cloudy days.

Wear protective clothing that protects your arms and legs. Self-examination is needed to look for a change in shape, size, color, and margins. If detected early, it can be treated quickly with less scarring. Photostable sunscreen four-hourly even indoors for ten days and 30 minutes before going outdoors. Is there a family history of melanoma or many moles on the body or dysplastic nevi?

Please reply.

Thank you doctor,

So you do not think these seven spots are Cafe Au Lait NF spots? We do use high-grade sunscreen at all times for them. She has not been sunburned, and we are very cautious, but her skin does get tanner in the summer with 20% zinc oxide sunscreen. Some of these spots seem to be there from birth and have darkened in her six years of life. Could it just be that she is prone to hyperpigmentation (like me) since she is a redhead and fair skin with a darkly pigmented mother? So these are not CALs, but you think they are benign melanocytic nevus?

#

Hello,

Welcome back to icliniq.com.

Yes, the lesions are benign melanocytic nevus. It is a common occurrence and mostly harmless. No, it is not cafe Au late NF spots. They usually occur on trunk (back) most common sites, and systemic complications occur, including neurological involvement. It is not NF. So do not worry. Do self-examination of the lesion. If any change present, it needs to be reported.


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