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Albright's syndrome

The patches in McCune-Albright syndrome are distinguished by their irregular, jagged "coast of Maine" borders, unlike the smooth borders of a typical café-au-lait macule.

Lentigo

A lentigo is a small, freckle-like macule, much smaller in size than a typical café-au-lait patch.

Linear nevoid hyperpigmentation

This is characterized by swirls and streaks of hyperpigmentation that follow the Lines of Blaschko, a linear pattern not seen in a café-au-lait macule.

Mastocytomas

A solitary mastocytoma is a reddish-brown plaque that urticates (forms a wheal) when stroked (Darier's sign), a reaction not seen in a café-au-lait patch.

Naevus spilus

This is distinguished by its unique appearance of a background café-au-lait patch with multiple smaller, darker melanocytic nevi speckled within it.

Neurofibromatosis

This is a systemic disease diagnosis, not a single lesion. The presence of six or more café-au-lait macules, along with other signs like axillary freckling or neurofibromas, is required.

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