Dyskeratosis congenita (DC) is an inherited bone marrow failure syndrome 
characterized clinically by the triad of abnormal nails, reticular skin 
pigmentation, and oral leukoplakia, and is associated with high risk of 
developing aplastic anemia, myelodysplastic syndrome, leukemia, and solid 
tumors. Patients have very short germline telomeres, and approximately half have 
mutations in one of six genes encoding proteins that maintain telomere function. 
Accurate diagnosis of DC is critical to ensure proper clinical management, 
because patients who have DC and bone marrow failure do not respond to 
immunosuppressive therapy and may have increased morbidity and mortality 
associated with hematopoietic stem cell transplantation.