Noninvasive treatment of cutaneous neurofibromas (cNFs): Results of a randomized prospective, direct comparison of four methods

Abstract

BackgroundPeople with Neurofibromatosis Type 1 (NF1) suffer disfigurement and pain when hundreds to thousands of cutaneous neurofibromas (cNFs) appear and grow throughout life. Surgical removal of cNFs under anesthesia is the only standard therapy, leaving surgical scars. ObjectiveEffective, minimally-invasive, safe, rapid, tolerable treatment(s) of small cNFs that may prevent tumor progression. MethodsSafety, tolerability, and efficacy of four different treatments were compared in 309, 2-4mm cNFs across 19 adults with Fitzpatrick skin types (FST) I-IV: radiofrequency (RF) needle coagulation, 755nm alexandrite laser with suction, 980nm diode laser, and intratumoral injection of 10mg/mL deoxycholate. Regional pain, clinical responses, tumor height and volume (by 3D photography) were assessed before, 3 and 6 months post-treatment. Biopsies were obtained electively at 3 months. ResultsThere was no scarring or adverse events >grade 2. Each modality significantly (p<0.05) reduced or cleared cNFs, with large variation between tumors and participants. Alexandrite laser and deoxycholate were fast and least painful; 980nm laser was most painful. Growth of cNFs was not stimulated by treatment(s) based on height and volume values at 3 and 6 months compared to baseline. LimitationsIntervention was a single treatment session; dosimetry has not been optimized. ConclusionsSmall cNFs can be rapidly and safely treated without surgery.