TABLE 4. Recommendations for Diagnostic Workup and Cancer Surveillance in Patients with PTEN mutations.

	Pediatric (<18 years)	Adult Male	Adult Female
Baseline Workup	Targeted History and Physical Examination Baseline Thyroid Ultrasound Dermatologic Examination Formal neurologic and psychological testing	Targeted History and Physical Examination Baseline Thyroid Ultrasound Dermatologic Examination	Targeted History and Physical Examination Baseline Thyroid Ultrasound Dermatologic Examination
Cancer Surveillance
From diagnosis	Annual Thyroid Ultrasound and Skin Examination	Annual Thyroid Ultrasound and Skin Examination	Annual Thyroid Ultrasound and Skin Examination
From age 30*	As per adult recommendations		Annual mammogram (for consideration of breast MRI instead of mammography if dense breasts) Annual endometrial sampling or transvaginal ultrasound (or from 5 years before age of earliest endometrial cancer)
From age 40*	As per adult recommendations	Biannual colonoscopy** Biannual renal ultrasound / MRI	Biannual colonoscopy** Biannual renal ultrasound / MRI
Prophylactic Surgery	Nil	Nil	Individual discussion of prophylactic mastectomy or hysterectomy.

^*Surveillance may begin 5 years before the earliest onset of a specific cancer in the family, but not later than the recommended age cutoff.

^**The presence of multiple non-malignant polyps in patients with PTEN mutations may complicate non-invasive methods of colon evaluation. More frequent colonoscopy should be considered for patients with a heavy polyp burden.