Non-invasive Treatment of Cutaneous Neurofibromas (cNFs): Results of a Randomized Prospective, Direct Comparison of Four Methods-Supplemental
Description
People 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. Safety, 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. There 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. Supplemental information included here includes three tables and three composite figures (13 figures total). Supplemental Table I. “Baseline tumor characteristics.” Supplemental Table II. “Adverse events across modalities.” Supplemental Table III. “Average physician-reported improvement scores.” Supplemental Figure 1. “Examples of clinical responses (arrows) 3 months after treatment.” Representative clinical responses after treatment with deoxycholate injection (A before treatment, B after treatment), alexandrite laser (C before treatment, D after treatment), 980nm laser (E before treatment, F after treatment) and RF (G before treatment, H after treatment) are displayed. Supplemental Figure 2. “Examples of histological responses after treatment.”Immediately after treatment with the alexandrite laser (A), subepidermal separation and extensive coagulation of distended blood vessels within the tumor is noted. Near-complete tumor clearance with mild fibrosis (not seen as a scar on clinical assessment) at the site of prior tumor is noted 3 months after treatment (B). When residual cNF was present histologically after treatment with any modality, its appearance was similar to that of control untreated tumors. (A: 20x, H&E; B: 40x, H&E) Supplemental Figure 3. “Examples of histological response 3 months after treatment with deoxycholate injection (A), 980nm laser (B) and RF coagulation (C).” When residual cNF was present histologically (A), its appearance was similar to that of control untreated tumors. No evidence of atypia, mitosis or tumor inflammation was noted (A-C). Mild fibrosis was present at the sites of prior tumor (A-C). (A-C 40x, H&E).