Sir.—In the September 1991 issue of AJDC1 Feingold described patients with Down syndrome with facial lesions. He found that 15 (46.9%) of the 32 patients with Down syndrome had syringomas. Although I do not disagree that patients with Down syndrome have an increased incidence of syringomas, none of these patients underwent a biopsy of these lesions for verification of the diagnosis. Multiple lesions in the periorbital area could not only be syringomas but trichoepitheliomas, xanthomas, and other adnexal tumors. For this reason I disagree with Dr Feingold's final statement, "... not subject the patient to an unnecessary evaluation."