CALM Borders May Predict Response to Laser Treatment

Café au lait macules (aka CALMs) tend to have borders that either resemble the coast of Maine (irregular) or the coast of California (smooth). These cosmetically troubling but benign lesions have an inconsistent response to laser treatment.

A recent study examined the morphological features of CALMs to determine whether they may provide a way to better predict response. Using a retrospective study design, authors looked at the medical records of patients with clinical diagnoses of CALM who were treated with several different laser types over a period of 11 years. Using clinical photographs, physicians who were blinded to the final morphological category evaluated pre and post treatment photograph. They identified the original morphologic subtype of each CALM (coast of Maine vs. coast of California) and then assessed improvement using a visual analog scale.

The results showed that morphologic subtype is highly predictive of response to laser treatment. Irregularly bordered coast of Maine lesions were far more likely to achieve good or excellent clearance than smooth-bordered coast of California lesions. For smooth-bordered lesions, a large number of treatments may be needed for only mild improvement.

The authors state that despite study limitations, such as the lack of information about the differences of laser modalities, these results can be used to inform patients about their expected outcomes depending on the appearance of their lesions.