A 22-year-old man comes to the office due to occasional dull headaches that awaken him from sleep. The patient has no associated neurologic deficits. There is no history of migraines in the family. His temperature is 37.2 C (99 F), blood pressure is 140/80 mm Hg, pulse is 60/min, and respirations are 12/min. On physical examination, there are several 3- to 5-cm flat, pigmented spots on his trunk. There are also multiple, subcentimeter, soft, fleshy, cutaneous tumors located on his trunk and neck.