We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Diagnostic and Management Considerations Posed by Multiple Café au Lait Spots

Vincent M. Riccardi, MD
Arch Dermatol. 2009;145(8):929-930. doi:10.1001/archdermatol.2009.180.
Text Size: A A A
Published online


Neurofibromatosis type 1 (NF1) is potentially a very serious disease. A cardinal feature of NF1 is the patchy hyperpigmentation of the skin variously known as café au lait macules (CALMs) or café au lait spots (CLSs). In this issue of the Archives, Nunley and coworkers1 document unequivocally that 6 or more CLSs, as the sole clinical finding, are especially useful for alerting clinicians to the ultimate diagnosis of NF1. That is, as the title of their article indicates, CLSs can be predictive of the diagnosis of NF1. The purpose of this editorial is to emphasize this conclusion and to discuss 2 further considerations: (1) NF1 CLSs in no way predict the nature and severity of the disorder once it fully manifests; and (2) CLSs overlapping in nature, number, and distribution with NF1 may indicate an alternative disorder. That is, clinicians must deal with both the heterogeneity of the clinical course of NF1 once its presence is confirmed and the heterogeneity of the final diagnoses among the referrals to an NF clinic.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

1 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles