Palmar melanotic macules. A sign of neurofibromatosis.

Multiple melanotic macules of varying sizes were present on the palmar surfaces of 42 of 50 consecutive South Indian patients with von Recklinghausen's disease. The histologic characteristics of the macules showed localized areas of fingerlike prolongations of the rete ridges with increased pigmentation of the basal cells. This epidermal change overlies a small neurofibroma accompanied by thick-walled blood vessels in the reticular dermis. A clinicopathologic correlation of these palmar melanotic macules constitutes yet another frequent and specific marker of classical neurofibromatosis.