Q: I recently noticed a cluster of light tan spots on my 11 year-old daughter’s upper back near the base of her neck. There are a dozen or so in about a 3” diameter area. They are about the size of the end of a pencil eraser or smaller and may have been present for several weeks or longer. As it is still winter and she is at that age where she likes her privacy, I don’t often see her undressed. The spots don’t itch and are smooth to the touch, not raised.
I started doing some research on the internet and came across discussions on cafe-au-laut spots. The possibility of neurofibromatosis is frightening. She doesn’t seem to have any other symptoms associated with that genetic disorder, so what else might cause the sudden appearance of these spots? Would her pediatrician be the one to see or would a dermatologist be better? My daughter is extremely “doctor phobic” due to two traumatic ER visits at ages 2 and 7. Thank you for your help.
A: Actually, you’re already on the right track. While your daughter may be uncomfortable around doctors, I recommend you begin with a visit to her pediatrician. He or she may take a quick look, know exactly what the spots represent, and be able to provide the information and treatment you seek. If the diagnosis is questionable, the next step would be to see a dermatologist. Perhaps your daughter will feel better if you can find a female in the profession, although exposing her lower neck area shouldn’t be too upsetting to her.
Cafe-au-lait spots are light tan, almost the color of coffee iced cream or coffee with milk added, although in some individuals the spots can be darker in color. And, you’re correct in that they may be associated with a genetic disorder known as neurofibromatosis. The spots that confirm the diagnosis of neurofibromatosis occur in about 1 of every 3500 individuals and can appear on males as well as females. Generally speaking, these spots are present at birth and there are no reports available to indicate they undergo malignant changes. They are commonly benign and produce no mortality or morbidity. The lesions are simply caused by an increase in melanin content and are essentially a type of birthmark that can occur for a variety of reasons and may not be indicative of any ailment at all.
Neurofibromatosis, (NF) also known as von Recklinghausen disease, is a genetically inherited autosomal disorder, meaning that only one copy of the affected gene is needed from a parent for the disorder to develop. If you or your husband have the disorder, any of your children will have a 50% chance of developing it, as well. Type 1 NF is the most common form and accounts for almost 90% of all reported cases. This particular disorder presents with raised lesions, something you indicate your daughter does not have. So with luck, you might be able to rule this one out.
Generally speaking, skin lesions are growths or patches of skin that differ from the area surrounding them. They can result from a wide variety of conditions and diseases and are grouped into two categories – primary and secondary. Those that are primary often vary in color and may be present from birth or may be acquired as an individual ages. Secondary lesions are changes that occur from scratching or picking at a primary lesion or from primary lesion changes. Your daughter may simply have a sensitivity or reaction to such elements as the sun and any treatment will obviously depend on the type of lesions she has. Because of their location and the fact that she is somewhat shy and uncomfortable around doctors, it may be impossible to determine when the spots first appeared. But the information might help extensively in making a diagnosis. Could she have had them since last summer when she might have been out of doors with a bathing suit or halter top on?
She should be seen by a health care professional who can put a diagnosis to what is seen and offer the best treatment available. Don’t delay. If you start with her pediatrician, be sure to explain why you want to be seen. The doctor may choose to send her directly to a dermatologist for faster answers. Good luck.
