The Schimmelpenning-Feuerstein-Mims syndrome (SFM), characterized by L
inear nevus sebaceous and ocular and neurologic abnormalities, is a sp
oradic condition without known familial cases or etiology. We report t
he occurrence of SFM in only one of two monozygotic (MZ) twins. After
considering a variety of possible causative mechanisms, we suggest tha
t a postzygotic dominant lethal mutation in mosaic form may best expla
in SFM and the discordancy for SFM in these MZ twins.