Cutaneous neurofibromas are the hallmarks of neurofibromatosis type 1 (NF1). They are composed of multiple cell types, and traditionally they are believed to arise from small nerve tributaries of the skin. A key finding in the context of this view has been that subpopulations of tumor Schwann cells harbor biallelic inactivation of the NF1 gene (NF1 ؊/؊ ). In the present study, our aim was to clarify further the pathogenesis of cutaneous neurofibromas. First, we detected cells expressing multipotency-associated biomarkers in cutaneous neurofibromas. Second, we developed a method for isolating and expanding multipotent neurofibroma-derived precursor cells ( Neurofibromatosis type 1 (NF1) is caused by mutations in the NF1 gene that encodes the tumor suppressor protein neurofibromin, an inactivator of Ras. Clinical diagnosis of the disease is based on the presence of café-au-lait macules, axillary freckling, hamartomas of the iris (Lisch nodules), optic pathway gliomas, distinctive osseous lesions such as sphenoid wing dysplasia or pseudarthrosis, and neurofibromas. 1 Neurofibromas can be classified according to their anatomical location: cutaneous, subcutaneous, intraneural, and plexiform. 2 Plexiform neurofibromas are congenital tumor masses involving nerve trunks and often extend to the skin, whereas cutaneous neurofibromas are not detectable at birth and usually appear during adolescence.Histologically, neurofibromas are mixed tumors consisting of cells with divergent differentiation characteristics. The use of traditional histological stains, as well as immunohistochemistry with a variety of biomarkers and electron microscopy, has been taken as proof for the involvement of Schwann cells, perineurial cells, and fibroblasts. 3-5 Neurofibromas also contain numerous mast cells and axonal processes, all of which are embedded in an abundant collagenous extracellular matrix. 4,6 Unlike plexiform neurofibromas, which carry a risk for malignant transformation and may form tumor masses of several kilograms, cutaneous neurofibromas invariably retain their benign phenotype. Their neoplastic cells never undergo malignant transformation and the tumor diameter usually varies from millimeters to 2 cm, rarely exceeding 3 cm.In light of previous reports and the current study, a feasible explanation for neurofibroma development involves a biallelic inactivation of the NF1 gene. 7,8 This inactivation has been detected in cultured cells displaying characteristics typical of Schwann cells, including a bipolar morphology and the expression of S100 protein.Previous studies have observed diploinsufficiency in 29 of 29 cutaneous neurofibromas in which two separate mutations were found in 26 of 29 tumors and loss of heterozygosity was found in 3 of 29 7 It should be noted that each of the second mutations was unique.