Treatment of Nodular Fasciitis Occurring on the Face

Abstract

BackgroundSurgical excision is generally recommended for the treatment of nodular fasciitis (NF) to rule out sarcoma. However, in cases of NF occurring on the face, the reported recurrence rate is higher and the surgical approach may result in considerable aesthetic concern.ObjectiveTo describe our experience with NF occurring on the face and evaluate the outcomes of surgical and nonsurgical methods of treatment.MethodsWe performed a retrospective review of 16 patients with NF on the face. The patients were treated with surgical excision or nonsurgical methods such as triamcinolone intralesional injection (TA ILI) and pinhole method with a carbon dioxide (CO2) laser.ResultsAmong the 16 patients, surgical treatment was performed in 9 and recurrence occurred in 7 of these 9 patients (77.8%). The recurred lesions showed regression after repeated TA ILI. On the other hand, five patients underwent nonsurgical treatment after the histologic exclusion of malignancy. Their lesions showed regression after repeated pinhole treatment and TA ILI. In one case, NF spontaneously regressed. On a visual analogue scale, the nonsurgical approach showed superior results. However, the values were not statistically significant (6.90±1.56 vs. 5.61±1.36; p=0.163). The satisfaction level was lower in patients who experienced recurrence after surgical excision.ConclusionSurgical treatment for NF on the face showed a noticeable recurrence rate and resulted in scarring. Therefore, considering the possibility of spontaneous regression, the nonsurgical method can be considered as an alternative treatment option for NF on the face.

Nodular fasciitis, a forgotten entity

“…NF is a benign, self‐limiting, reactive, pseudosarcomatous process composed of fibroblasts and myofibroblasts. It is the most common of the benign fibroblastic proliferative lesions of the soft tissue and exceeds in frequency any other tumor or tumor‐like lesion among this category …”

“…Negative expression of CD34 is useful to rule out a sarcomatous nature of the lesion. NF may be positive for CD‐68 or KP‐1, a histiocyte‐specific marker …”

“…First‐line treatment of NF is surgical removal. Even after partial resection, tumor relapse is below 10% . Patients treated with intralesional corticosteroid injection with good clinical response have also been reported .…”

“…It is the most common of the benign fibroblastic proliferative lesions of the soft tissue and exceeds in frequency any other tumor or tumor-like lesion among this category. 3 The pathogenesis of NF is unknown. The etiology has been associated with previous trauma in 5-10% of the cases and has been related to a hyperresponse mechanism triggering an increase in mitotic activity in certain predisposed individuals.…”

“…The etiology has been associated with previous trauma in 5-10% of the cases and has been related to a hyperresponse mechanism triggering an increase in mitotic activity in certain predisposed individuals. 3 After incisional biopsy, the evolution of the lesion can be unpredictable. In certain cases, a rapid enlargement of the mass can be observed.…”