Café au lait macules (CALMs) are well circumscribed, homogenous light brown macules that occur as isolated lesions in the general population. Their prevalence varies amongst ethnicities but ranges from 0.2% to 18%.35 Café au lait macules may also be found as multiple lesions in association with a syndrome (e.g., neurofibromatosis, Noonan syndrome). Histologically, there is an increase in melanocytes along the basal layer, hypermelanosis of melanocytes and keratinocytes,and giant melanin granules. Treatment of CALMs with lasers is minimally successful and often unpredictable.Temporary lightening or clearing can be achieved after multiple treatments (Fig. 10). However, recurrences are seen in up to 50% of treated lesions, even when clearing is initially achieved. Post-inflammatory hyperpigmentation is frequent following laser treatment of CALMs, especially in patients with darker skin types. Alster demonstrated complete elimination of most CALMs after an average of 8.4 treatment sessions with the 510 nm pulsed dye laser, indicating that multiple treatments are needed for complete resolution.Er:YAG resurfacing has also been shown to eliminate CALMs.