Early treatment of occult spinal dysraphism may prevent progressive neurological deficits. Diagnosis is often delayed until the onset of irreversible neurological damage. A review of data from the literature and present patients suggests that lumbosacral skin abnormalities such as tufts of hair, hemangiomas, lipomas, skin tags or pigmented nevi should alert the physician to search for occult spinal dysraphism. In the asymptomatic patient with a skin lesion, roentgenography of the lumbosacral spine is a useful screening procedure for identifying treatable underlying problems.