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Note what signs you see.
I (N.X., M.D.) see scapula alata (wing-like scapulae or omoplatus). The skin shows multiple café-au-lait spots (CaL). I also note a red nevus (angioma), probably a Morgan angioma (near upper left shoulder).
PERSPECTIVE: In contrast to the trunk where CaL and neurofibromas are most frequent, the face is often virtually not or minimally impacted. This is one of several examples of the preferential location of CaL. Furthermore, scapula alata or winged scapula often is a sign of muscular pathology. There is some suggestion that this patient may be developing scoliosis. In any case this sign needs to be assessed.
Please also see the gallery of NF1 signs.