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Discussion
CM-AVM is an autosomal dominant disorder with a high penetrance and de novo occurrence.1 The incidence of CM-AVM syndrome is not known. In the first large study reported in the literature, 45 of 140 individuals were from a Belgium French-speaking population of 4 million people, with an estimated prevalence of 1 per 100,000 caucasians (Revencu, 2008).3 In our area, we have found a similar prevalence, i.e., seven cases in a population of 820,000 people (0.85/100,000).
CM-AVM is a clinically and genetically heterogeneous syndrome,1-14 and its clinical diagnosis is based on the identification of the characteristic small, multifocal CMs. Because large CMs up to 15 cm can appear and the reported number of CMs in individual cases can range from 1 to 60, evidence of RASA1 mutation or familial history of CMs or AVMs allows the diagnosis of doubtful cases. Probable or definitive diagnostic categories have been proposed for this entity (Orme 2013).4
AVMs appear in one-third of individuals with CM-AVM and may occur on the skin, muscle, bone, spine and brain; however, the liver and lungs are not involved.6 In a recent literature review, symptomatic spinal or intracranial AVMs occurred in more than 7% of patients with this syndrome and usually experienced symptoms in the first 7 years of life (Orme 2013).4 Moreover, in a retrospective study, 43% of children presenting with cerebral hemorrhage secondary to arteriovenous malformation showed the CM-AVM phenotype (Chee 2010).15 This potentially severe morbidity has raised a concern about the use of cerebral and spinal MRI as a screening tool in all patients. Management is still controversial because many affected individuals with or without AVM are asymptomatic and it has not been defin...

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... involved in the hair follicle proliferation and cell cycle. However, the small number of patients examined limits our study. Therefore, it is necessary to evaluate hair reduction on the CMs in larger series to determine whether this finding can be useful to differentiate between lesions associated with CM-AVM syndrome and other CMs, such as classic PWS.
In conclusion, our study confirms that small white anemic halos with red punctate spots on the upper limbs or small grouped telangiectasias on the neck or upper trunk are frequent findings in CM-AVM syndrome. In addition, the observed alopecia on the CMs suggests that RASA1 gene mutations could be involved in the hair follicle proliferation and cell cycle. Further studies to confirm this association are needed, and would be of interest to investigate novel therapies for hair disorders such as alopecia and hirsutism

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