• Perform a detailed clinical dermatologic inspection/exam annually. • Rapidly changing, disfiguring, or symptomatic TSC-associated skin lesions should be treated as appropriate for the lesion and clinical context, using approaches such as surgical excision, laser(s), or possibly topical mTOR inhibitor. • Facial angiofibromas (And some other skin lesions) respond to systemic or topical mTOR inhibitor; which can prevent more severe disease later if started early (27, 28). This evidence concerns the gene MTOR and tuberous sclerosis.