A 10-year-old with scoliosis and axillary freckling is evaluated. What is the most appropriate management at this time?

• A. Oncology consult
• B. Bracing
• C. Serial XRAYs (q6 months)
• D. Surgical consult

Answer: (A)

Noting axillary freckling in a child with scoliosis triggers suspicion for neurofibromatosis type 1, a condition that markedly increases the risk of nerve-related tumors such as plexiform neurofibromas and optic pathway gliomas. The most appropriate step is to bring in oncology for comprehensive surveillance and coordinated multidisciplinary care. This approach ensures early detection and management of potential tumors, guides genetic counseling, and organizes ongoing monitoring, which is crucial in NF1. While scoliosis in NF1 can require orthopedic input, the immediate priority given these findings is tumor surveillance and a coordinated NF1 evaluation, not just spine-focused management.