RASopathies. Part II: Cutaneous and extracutaneous manifestations

Many RASopathies can be clinically diagnosed based on their cutaneous findings, thus it is essential for dermatologists to be comfortable differentiating RASopathies for accurate diagnosis and appropriate management. Employing the same framework to categorize as in Part I, the most common RASopathies include those principally caused by genetic variants in tumor suppressor genes (neurofibromatosis type 1, Noonan syndrome with multiple lentigines, Legius syndrome, capillary malformation-arteriovenous malformation syndrome), those principally due to variants in oncogenes (Noonan syndrome, Costello syndrome, cardiofaciocutaneous syndrome), and mosaic conditions such as sebaceous nevus syndrome, neurocutaneous melanosis, McCune-Albright syndrome, phakomatosis pigmentokeratotica, epidermal nevus syndrome, and encephalocraniocutaneous lipomatosis. Germline variants cause systemic disease and must be managed in conjunction with a multidisciplinary team of specialists for holistic care. Common extracutaneous manifestations affect the neurologic, psychiatric, cardiac, ocular, musculoskeletal, genitourinary, and hematologic systems. The genetic basis of disease necessitates family counseling with a geneticist and patient support groups. It is also important to recognize risk of cancer in RASopathy patients for appropriate surveillance. Thus, dermatologists play a critical role in patients' healthcare through familiarity with and prompt diagnosis of RASopathies.