A recent study published in the Journal of the American Academy of Dermatology suggests that noninvasive treatments may provide a viable alternative to surgical removal for small cutaneous neurofibromas (cNFs) in individuals with neurofibromatosis type 1 (NF1). NF1 patients commonly experience disfigurement and pain due to the presence and growth of hundreds to thousands of cNFs throughout their lives. Traditionally, surgical removal under anesthesia has been the standard therapy, often leaving behind surgical scars.
The prospective, randomized, direct comparison trial involved 19 participants, each with a minimum of six cNFs ranging from 2 mm to 4 mm in diameter on the trunk, arms, or legs. The researchers assessed the safety, tolerability, and efficacy of four different minimally invasive treatments for small cNFs, with the potential to prevent tumor progression, namely radiofrequency (RF) needle coagulation, 755 nm alexandrite laser with suction, 980 nm diode laser, and intratumoral injection of 10 mg/mL deoxycholate. A total of 309 cNFs were treated, and the participants had Fitzpatrick skin types (FST) I-IV. The study evaluated regional pain, clinical responses, tumor height, and volume (measured by 3D photography) before and at 3- and 6-months post-treatment, with biopsies obtained electively at 3 months.
The study results demonstrated that all four modalities significantly reduced or cleared cNFs, with no scarring or adverse events exceeding grade 2. Alexandrite laser and deoxycholate injection were noted as fast and less painful options, while the 980 nm laser was identified as the most painful. Importantly, the treatments did not stimulate the growth of cNFs based on height and volume values at 3 and 6 months compared to baseline. Common adverse events included local erythema and edema immediately post-treatment, with 26% of patients experiencing hypopigmentation at alexandrite laser sites.
The study findings concluded that small cNFs can be effectively, rapidly, and safely treated without resorting to surgery. Future trials are planned to further optimize treatment parameters, explore wider treatment ranges, and include younger patients in the study cohort. The results of this study open avenues for the development of minimally invasive interventions that may improve the quality of life for individuals with NF1 by offering a less invasive and potentially more tolerable alternative to surgical procedures.
Reference
Richey P, Funk M, Sakamoto F, Plotkin S, Ly I, Jordan J, et al. Noninvasive treatment of cutaneous neurofibromas (cNFs): Results of a randomized prospective, direct comparison of four methods. Journal of the American Academy of Dermatology [Internet]. 2023 Dec 9 [cited 2024 Jan 8].