We have identical twin girls who are six years old. Both have hyperpigmented spots, but one of them has more than the other and a bit larger. They are tan, a little indistinct, and several with ragged edges. We have been able to identify seven spots. It appears they have darkened as we have not noticed several of them in prior years. Their pediatrician has never said anything regarding the spots. I have attached the pictures and circled the areas. These are specified on her legs and arms. None are located on her trunk, face, neck, or buttocks. I also included a family picture, showing the differences in our pigmentation. Now that we have noticed these, my partner and I are very concerned that these could be a sign of NF1. She does not have any freckling spots in her inguinal, neck, or axillary areas. The only freckles she has are on her cheeks and nose, like her sister. The girls have their annual check-up next week, and we have set a subsequent dermatologist appointment for next month, to be sure. The girls did have their first eye doctor appointment several months ago, and the optometrist stated everything looked great. Could the hyperpigmentation be due to our contrasting pigmentation? I am a redhead myself, and my wife has a much darker complexion. I have a couple of hyperpigmented ragged spots on my leg, as well, but none as large as hers. Do these spots concern you for further evaluation of NF1 and Cafe Au Lait.