A 2-year-old child presents to the nurse practitioner with eight café-au-lait spots on the back and chest. These lesions have irregular borders and measure between 1.5 and 2 cm in diameter. The nurse practitioner should:

Rationale: A. While café-au-lait spots can appear as benign birthmarks, the presence of six or more spots greater than 0.5 cm in prepubertal children is a diagnostic criterion for neurofibromatosis type 1 (NF1). Reassurance alone is inappropriate in this scenario. B. Topical hydrocortisone is not indicated, as café-au-lait spots are pigmented lesions, not inflammatory or eczematous conditions. C. Antifungal cream is irrelevant, as café-au-lait spots are not caused by fungal infections. D. Referral to a neurologist or pediatric geneticist is warranted for further evaluation, as NF1 can be associated with neurologic, skeletal, and ophthalmologic complications. Early identification allows for monitoring and management of potential systemic involvement.