In neurofibromatosis type 1 (NF-1), malignant transformation of internal plexiform neurofibromas carries a poor prognosis, in part because they are not evident clinically. In this issue, Sbidian et al. describe a novel "NF-1Score" equation that employs four easily observable traits to predict the presence of paraspinal neurofibromas. This tool can identify at-risk patients during regular screening to help reduce mortality.