There are many forms of birthmarks that are brown, black or blue in color. These appear usually at birth or in the first few years of life. There are also brown birthmarks that appear during teenage years. Cafe au let macule are one of the most commonly found birthmarks that are tan, light brown, dark brown or blackish in color and can be found anywhere in the body. If you have six or more cafe us let macules, you should show these to a dermatologist to look for associated syndromes. Many patients are bothered by cafe au macules. Dr. Rokhsar routinely uses q switched alexandrite laser or a Pico laser to treat cafe au let macules successfully. One or more treatments may be required. There is a risk of incomplete clearance as well as a risk that they can recur after laser treatments. Each Cafe au let macule has its own “personality” and responds differently to the pigment laser. Another pigmented birthmark is nevus of ota (ito). These present with deep black or bluish discoloration mostly on any area of the face and often affect the upper and lower eyelids as well. These birthmarks are particularly bothersome to patients as most find them disfiguring. Nevus of ota typically responds very well with often full clearing achieved within 3-6 sessions. Dr. Rokhsar is an expert in treating pigmented birthmarks with various nano and Pico pigment lasers. Other pigmented birthmarks include Becker’s nevus. These usually present as tan or brown macules often on the torso, shoulders, chest, back, thighs or legs. They are usually characterized by an increase in hair follicles as they are hairy. Dr. Rokhsar uses a combination of pigment nano or Pico lasers in addition to laser hair removal lasers to target the extra pigment as well as the hair follicles. Three to 6 sessions of combination lasers may be required for significant improvement. There are a variety of other pigmented or brown birthmarks including congenital nevi and nevus spilus. Congenital nevi or hairy nevi can grow hair in them and are harder to treat. They can be treated with lasers or surgical excision. Dr. Rokhsar has used both lasers and staged surgical excision with great success avoiding the use of tissue expanders and the need for skin grafts. Nevus spilus looks like a speckled nevus and also responds well to q-switched and Pico lasers. Multiple treatments are often needed.