Multiple facial angiofibromas and collagenomas in patients with multiple endocrine neoplasia type 1

Objective: To evaluate patients with multiple endocrine neoplasia type 1 (MEN1) for cutaneous manifestations. Design: Survey during a 3-year period. Setting: The National Institutes of Health, a tertiary referral research hospital in Bethesda, Md. Patients: A consecutive sample of 32 individuals with previously diagnosed MEN1 who were not preselected for the presence of skin lesions were examined for cutaneous abnormalities. None of the patients or family members were diagnosed as having tuberous sclerosis. Interventions: lesions were identified by clinical appearance, photographed, and confirmed histologically. Main Outcome Measure: To determine the frequency of skin lesions in patients with MEN1. Results: Multiple facial angiofibromas were observed in 28 (88%) of the patients with MEN1, with 16 patients (50%) having 5 or more. Angiofibromas were clinically and histologically identical to those in individuals with tuberous sclerosis. Collagenomas were observed in 23 patients (72%). Also observed were cafe au lait macules in 12 patients (38%), lipomas in 11 patients (34%), confetti-like hypopigmented macules in 2 patients (6%), and multiple gingival papules in 2 patients (6%). Conclusions: Multiple angiofibromas, collagenomas, lipomas, confetti-like hypopigmented macules, and multiple gingival papules are cutaneous manifestations of MEN1 and should be looked for in both family members of patients with MEN1 and individuals with hyperparathyroidism or other MEN1-associated tumors. Multiple angiofibromas can no longer be considered pathognomonic for tuberous sclerosis. The observation of angiofibromas in individuals without tuberous sclerosis necessitates further biochemical testing for MEN1.