Comparative study of CO2- and Er:YAG laser ablation of multiple cutaneous neurofibromas in von Recklinghausen's disease

Abstract

With a prevalence of 1 in 3,000 births, neurofibromatosis type 1 (NF1) is one of the most common genetic disorders and is characterized by an uninhibited expansion of neural tissue. Occasionally, severe deformities occur, but frequently considerable cosmetic disfigurement is caused by the development of hundreds of benign cutaneous neurofibromas. The objective of this study was to evaluate the erbium:yttrium-aluminium-garnet (Er:YAG) laser as a therapeutic option for the removal of multiple cutaneous neurofibromas. In this prospective, comparative, in vivo study, 15,580 neurofibromas (44 operations on 21 patients) were removed via electrosurgery, CO2- or Er:YAG laser ablation. In 12 adjacent test areas, we compared the zone of thermal necrosis, the postoperative pain, the time to reepithelialization, the duration of postoperative erythema and the cosmetic outcome of these surgical methods. When compared to electrosurgery and CO2 laser ablation, the Er:YAG laser ablation outperformed the other methods of tumor removal. Rapid healing by second intention as well as the minimal discomfort and scar formation following Er:YAG laser ablation were noted. After 36 months of follow-up, permanent dyspigmentation was rare and hypertrophic scarring was not observed. Er:YAG laser vaporization of multiple cutaneous neurofibromas is a simple and rapid procedure that results in significantly better cosmetic results than CO2 laser treatment or electrosurgery.

Cutaneous neurofibromas in the genomics era: current understanding and open questions

“…Treatment options for cNFs are limited to elective surgical approaches or laser-based ablation of cNFs. 99 , 100 Other techniques have been applied for the removal of cNFs, including electrodessication and radiofrequency ablation. 100 – 102 Surgical/ablative approaches involve a risk of scarring and skin discoloration, 100 , 103 and surgical approaches are not practical in patients with numerous cNFs.…”

“… 99 , 100 Other techniques have been applied for the removal of cNFs, including electrodessication and radiofrequency ablation. 100 – 102 Surgical/ablative approaches involve a risk of scarring and skin discoloration, 100 , 103 and surgical approaches are not practical in patients with numerous cNFs. These clinical deficiencies emphasise a need for novel, genomically guided therapies that are based on a greater understanding of the molecular and cellular mechanisms that underlie NF1-associated cNFs, and at the time of writing, nine interventional clinical trials were identified for cNFs (Table 1 ).…”

Robust surgical approach for cutaneous neurofibroma in neurofibromatosis type 1

“…Local infection rate has been reported up to 15%, and scarring is a frequently observed (15,(27)(28)(29). Minimally invasive photocoagulation, including Er:YAG or Nd:YAG lasers, has been successfully implicated as a recent treatment option for small-to medium-sized cNFs, with complications such as postinflammatory hyperpigmentation occurring in 4% of tumors, yet the access is limited to large academic centers (30,31). Other destructive methods, including electrodessication and radiofrequency ablation, have shown high patient satisfaction outcomes 6 months postprocedure but should be considered as second-line therapies because of the high risks of aberrant scarring and hypopigmentation associated with the techniques (10,31,32).…”

Update on Genetic Conditions Affecting the Skin and the Kidneys

“…Neurofibromas as the main cutaneous finding in NF1 can be itchy, lead to disfigurement, and cause psychological strain. They can be treated with excisions or laser ablation (Er:YAG or CO 2 laser) ( 48 , 49 ), both with risk for hypertrophic scarring and recurrence ( 42 ).…”