An Update on Neurofibromatosis Type 1: Not Just Café-au-Lait Spots and Freckling. Part II. Other Skin Manifestations Characteristic of NF1. NF1 and Cancer

Actas Dermosifiliogr. 2016 Jul-Aug;107(6):465-73. doi: 10.1016/ Epub 2016 Mar 5.
[Article in English, Spanish]


Neurofibromatosis type 1 (NF1) is the most common neurocutaneous syndrome and probably the one best known to dermatologists. Although the genetic locus of NF1 was identified on chromosome 17 in 1987, diagnosis of the disease is still based primarily on clinical observations. The 7 diagnostic criteria of the National Institutes of Health, which were established in 1988, include 3 skin manifestations (café-au-lait spots, freckling on flexural areas, and cutaneous neurofibromas). The age at which these diagnostic lesions appear is variable: onset can be late in some patients while others never develop certain symptoms. Definitive diagnosis may therefore be delayed by years. Although the appearance of the characteristic café-au-lait spots and freckling in the early years of childhood are very suggestive of the disease, these signs are not pathognomonic and, in isolation, do not constitute sufficient evidence to establish a definitive diagnosis. Thus, other diagnoses should be considered in patients whose only symptoms are café-au-lait spots and freckling. By contrast, the presence of multiple cutaneous neurofibromas or at least 1 plexiform neurofibroma is a very specific indication of NF1. Identification of the different types of neurofibroma allows us to confirm the diagnosis and initiate appropriate management.

Keywords: Consejo genético; Genetic counseling; Glioma; Glomus tumor; Juvenile xanthogranuloma; Malignant peripheral nerve sheath tumor; Melanoma; Neurofibromatosis tipo 1; Neurofibromatosis type 1; Nevus anemicus; Tumor glómico; Tumor maligno de vaina nerviosa de nervio periférico; Xantogranuloma juvenil.

Publication types

  • Review

MeSH terms

  • Cafe-au-Lait Spots / pathology*
  • Humans
  • Melanosis / pathology*
  • Neurofibromatosis 1 / pathology*
  • Skin Neoplasms / pathology*