Nodular Fasciitis: An Uncommon Disease With Common Medical Management Challenges at a Remote Naval Hospital

Abstract

Nodular fasciitis is a rare benign soft tissue lesion that is often confused with malignant sarcoma, which can make management of this pathology challenging. We present here a case of head and neck nodular fasciitis that was managed at a remote U.S. Naval Hospital with limited diagnostic and therapeutic resources. The aim of this article is to bring to light this uncommon pathology so that it can be given its due consideration in the differential diagnosis from both a clinical and pathologic perspective. However, the more important purpose of this article is to highlight the complex decision-making process that sometimes occurs when evaluating patients within a medical infrastructure that is significantly less than that of a typical military treatment facility or U.S. hospital. Young surgeons and other providers may find this discussion useful before deploying, whether it be to a remote land-based facility or to an aircraft carrier.

Treatment of Nodular Fasciitis Occurring on the Face

“…Second, surgical procedures may act as another precipitating factor as NF is a myofibroblast proliferation that can be initiated by local injury. In this retrospective study, seven of nine patients (77.8%) who received surgical excision experienced local recurrence, which was a higher rate than those reported for other areas of the body 10 11 . We assume that this result may be due to the difficulty in achieving complete surgical excision in facial lesions or the increased trauma caused by surgery.…”

“…Because malignant transformation seldom occurs in benign skin lesions, treatment is not always a requirement as long as patients do not mind the cosmetic problems resulting from the skin lesions. In cases of NF on the face, proactive efforts are needed to perform histopathologic evaluation and treatment because NF tends to grow rapidly on the face of adults between the age of 20 and 40 years (i.e., persons who are involved in many social activities) 10 .…”

Nodular fasciitis of the orbit: rapid growth phase post iatrogenic incisional trauma

“…NF has no malignant potential and prognosis is excellent with complete marginal excision widely considered to be curative [ 8 ]. Recurrence is generally rare, however, in cases of recurrence some studies have reported the effective use of targeted steroid injections [ 8 ]. NF has also been shown to spontaneously regress without treatment [ 8 ].…”

“…Recurrence is generally rare, however, in cases of recurrence some studies have reported the effective use of targeted steroid injections [ 8 ]. NF has also been shown to spontaneously regress without treatment [ 8 ]. Even in cases of partial excision, spontaneous regression has been reported [ 8 ].…”

“…NF has also been shown to spontaneously regress without treatment [ 8 ]. Even in cases of partial excision, spontaneous regression has been reported [ 8 ]. It is still not well understood why spontaneous regression or resolution occurs in some cases, while in others proliferation occurs [ 8 ].…”