Treatment of Cutaneous Neurofibromas in Patients with Neurofibromatosis Type 1

Abstract

Neurofibromatosis type 1 is a genetic disorder impacting approximately 2.5 million people worldwide, often leading to development of numerous benign yet disfiguring cutaneous neurofibromas (cNF). Removal of cNF is limited to excision or laser ablation with common post-operation complications and scarring. The current case explores a new approach to removal or reduction of cNF by a minimally invasive and pain-reduced treatment modality. A 40-year-old female patient with numerous cNF across her body underwent a single treatment using a 20 MHz dermatologically focused ultrasound device on seven selected cNF on the upper back. Each cNF was treated in a single session of 20–60 s without anesthesia due to manageable pain. Only one minimal adverse reaction in the form of dyspigmentation in a single treated tumor was noted from treatment or during the healing of a thin scab that formed on each cNF a few days after treatment. At the 12-month follow-up, four out of seven treated cNF showed full remission, two showed partial or significant reduction in tumor volume, while two did not respond to treatment. The reason for the variability is not fully understood, but speculations include difference in tissue content, e.g., due to tumor age. The method is concluded to be a promising candidate for a new safe and minimally invasive treatment that can potentially be used for single-session removal/reduction of a large number of cNF. Further research should focus on refining treatment parameters and strategies to enhance response predictability.

Recalcitrant Basal Cell Carcinoma after Grenz Ray Therapy: Introduction of High-Intensity Focused Ultrasound for Minimally Invasive Management

“…HIFU is performed in a few minutes per lesion with or without local anesthesia. It spares hair follicles, and immediate posttreatment complaints and the posttreatment healing phase are met with acceptance by the patient and widely uncomplicated; no sutures to be removed [ 10 – 12 ]. As mentioned initially, the policy of obligatory pretreatment biopsy in itself causing sequelae is not, albeit rational, optimal in the long perspective of control of grenz ray-induced skin malignancies with cancers constantly showing up, some in native or early state manifested as actinic keratoses and others as BCC according to clinical diagnosis and dermoscopy.…”

“…Recently, a 20 MHz high-intensity focused ultrasound (HIFU) device has been launched in European university hospitals and private clinics with special dedication as a safe and efficient method for noninvasive treatment of a range of dermatological conditions including actinic keratosis and BCC [ 10 – 12 ]. The system delivers focal points with thermomechanical insults that can be positioned directly in the skin and in the BCC under direct dermoscopic guidance.…”

Case report: Sequential treatment strategy for advanced basal cell carcinoma in Gorlin-Goltz syndrome: integration of vismodegib, radiotherapy, surgery, and high-intensity focused ultrasound

“…This capability allows for a spectrum of responses, ranging from mild localized heating to comprehensive tissue ablation. Furthermore, the non-invasive nature of HIFU offers a substantial advantage in treating various conditions without necessitating surgical intervention, thereby reducing potential side effects and complications commonly associated with invasive procedures ( 34 , 36 ).…”

Healing Process after High-Intensity Focused Ultrasound Treatment of Benign Skin Lesions: Dermoscopic Analysis and Treatment Guidelines

“…This advancement opens the door to effectively address a range of dermatological and aesthetic conditions [14,15]. HIFU has already proven its effectiveness in many skin disorders, including cutaneous neurofibromas, seborrheic keratosis (SK), condyloma acuminata, common warts, and many others [7,9,16]. Although treatment of skin lesions with HIFU is becoming more common, there is still a lack of information regarding the healing process itself.…”

“…Some papers indicate that the immediate effects of HIFU treatment observed in the treatment field were local whitening and swelling in round areas [6]. At the end of the treatment, sometimes blister-like white swelling and sometimes thin scabs are observed [6,16]. Importantly, the healing process looks different depending on the type of lesions treated [18].…”