Photothermal(laser) therapy for my daughter's lesion was never indicated. She only has one on her leg about 3 inches long and 2 inches wide, so cosmetics was never really a concern.
I read once that cryosurgery or dermabrasion can be used, but it leaves some scarring.
I cannot emphasize enough the importance that you not rely solely on her ped's diagnosis. (Ped's are great, but not for this.)
You should take her to a dermatoligist and make sure this diagnosis is correct. Then you should proceed. Perhaps you can even ask your Dermatolgist if he/she has patients that have gone through this, went with laser treatment, etc. This may help you in making your decision.
And definately hook up with someone on the board that has already taken the laser route. Then decide if laser would be right for your child.
P.S. I talked to my daughter about this. I asked her if she had been born with the cafe au lait on her face, if SHE would want it removed. She said no if it wasn't something that could hurt her. I was surprised, particularily since she is 15, and kids can be so cruel. She said it was part of her, part of her heritage(she is Puorto Rican and her Grandma has one, as does her Dad--for her, this makes it cool
Another thing she said was kids will find something to tease you about, as long as they know it bothers you, its ammo.
I guess how you approach this, if cosmetic, depends on how sensitive she is going to be about her birthmark. At this age, it's pretty hard to judge.
My daughter said she would talk to you about her birthmark if you want. She has been teased once about it(and only once), but she is so comfortable with it because of how we addressed it in our home. In her case, it makes her special.
It's a Mom's call I guess.
Rivka (and Yakira)