Familial multiple discoid fibromas: A look-alike of Birt-Hogg-Dub e syndrome not linked to the FLCN locus Theo M. Starink, MD, PhD, a Arjan C. Houweling, MD, PhD, b Martijn B. A. van Doorn, MD, PhD, a Edward M. Leter, MD, PhD, b Elisabeth H. Jaspars, MD, PhD, c R. Jeroen A. van Moorselaar, MD, PhD, d Piet E. Postmus, MD, PhD, e Paul C. Johannesma, MD, e Jan Hein van Waesberghe, MD, PhD, f Martijn H. Ploeger, RN, b Marieke T. Kramer, MSc, b Johan J. P. Gille, PhD, b Quinten Waisfisz, PhD, b and Fred H. Menko, MD, PhD b Amsterdam, The Netherlands Background: Previously, we proposed that familial multiple trichodiscomas (OMIM 190340) is distinct from Birt-Hogg-Dub e syndrome (BHD) (OMIM #135150). BHD is characterized by multiple fibrofollicu- lomas/trichodiscomas, lung cysts, pneumothorax, and renal cell cancer. Germline FLCN mutations can be detected in most but not all BHD families. Objective: We sought to evaluate familial multiple trichodiscomas at a clinical and genetic level. We now renamed this condition ‘‘familial multiple discoid fibromas’’ (FMDF) to emphasize the distinction from BHD. Methods: In 8 additional families with an autosomal dominant pattern of multiple discoid fibromas we assessed the clinical findings and the histopathological features of skin lesions. FLCN germline mutation analysis was completed in 7 families. In two of these families segregation analysis was performed using polymorphic DNA markers in and around the FLCN locus. Results: The clinical findings in FMDF are different from those in BHD with early onset of skin lesions, prominent involvement of the pinnae, and discoid fibromas without the follicular epithelial component characteristic of the fibrofolliculoma/trichodiscoma spectrum of BHD. In addition, there were no evident pulmonary or renal complications. In none of the families were pathogenic FLCN germline mutations identified. Using segregation analysis we could exclude involvement of the FLCN locus in the two kindreds tested. Limitations: The prevalence of FMDF is presently unknown. The underlying gene defect has not yet been identified. Conclusions: FMDF is clinically distinct from BHD and is not linked to the FLCN locus. ( J Am Acad Dermatol 2012;66:259.e1-9.) Key words: angiofibroma; Birt-Hogg-Dub e syndrome; discoid fibroma; fibrofolliculoma; FLCN; folliculin; sclerotic fibroma; trichodiscoma. I n 1977, Birt et al 1 described a large family with autosomal dominantly inherited fibrofollicu- lomas, trichodiscomas, and acrochordons. The syndrome, now known as Birt-Hogg-Dub e syndrome (BHD) (OMIM #135150) is clinically From the Birt-Hogg-Dub e Working Group, Departments of Der- matology, a Clinical Genetics, b Pathology, c Urology, d Pulmono- logy, e and Radiology, f VU University Medical Centre. Funding sources: None. Conflicts of interest: None declared. Accepted for publication November 6, 2010. Reprint requests: Theo M. Starink, MD, PhD, Department of Dermatology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: thm.starink@ vumc.nl. Published online July 27, 2011. 0190-9622/$36.00 Ó 2010 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2010.11.039 Abbreviations used: BHD: Birt-Hogg-Dub e syndrome FMDF: familial multiple discoid fibromas FMT: familial multiple trichodiscomas 259.e1