Birthmarks may be present at birth or develop shortly thereafter. Two major types of birthmarks that we treat are vascular or pigmented. Vascular birthmarks include hemangiomas and port wine stains. While hemangiomas typically self-resolve, port wine stains progressively darken and thicken with time, making distinction between these two lesion types important. Vascular birthmarks may be treated with vascular-specific lasers, such as the V-beam pulsed dye laser. Early intervention generally leads to more rapid resolution. Pigmented birthmarks such as café-au-lait spots, Nevus of Ota and Becker’s nevus can sometimes be improved with laser treatments. Surgical excision for congenital nevi is sometimes appropriate.