Neurofibromatosis Type 1

A 7-year-old child presents with multiple light-brown oval macules on the trunk and back, the largest 3 cm in diameter. Examination also reveals axillary and inguinal freckling, four dome-shaped cutaneous neurofibromas, and bilateral Lisch nodules on slit-lamp examination. The father has similar skin lesions and a plexiform neurofibroma of the leg. The condition marked **A** in the diagram is suspected. Which of the following is NOT a recognized diagnostic criterion for this condition according to the 2021 NIH Revised Diagnostic Criteria?

A 9-year-old girl is referred to pediatric genetics clinic for evaluation of multiple brown skin lesions present since infancy that have increased in number and size over the past 3 years. Her father, paternal aunt, and paternal grandmother have similar skin markings. On examination, the structure marked **A** is noted—more than 15 lesions, each greater than 5 mm in maximal diameter with regular smooth edges distributed over the trunk, back, and limbs. Bilateral axillary freckling, multiple cutaneous neurofibromas, and a plexiform neurofibroma on the left paraspinal region are also present. Slit-lamp examination reveals bilateral Lisch nodules. Which of the following best describes the clinical significance of the lesions marked **A** in the diagnosis of Neurofibromatosis Type 1?