Non-excision treatment of multiple cutaneous neurofibromas by laser photocoagulation

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder characterized by skin tumours derived from peripheral nerves. It is a clinically diagnosed disorder of a mainly cosmetic concern. There are different excision modalities for treatment of cutaneous neurofibromas; however, none is considered to be universally accepted treatment. This study was conducted to evaluate a non-excision treatment of multiple cutaneous neurofibromas, using surface and interstitial approaches of neodymium:yttrium aluminum garnet (Nd:YAG) laser (1,064 nm) photocoagulation, depending upon the size and location of the lesions. Twelve patients with multiple cutaneous neurofibromas were included. Surface laser photocoagulation by long-pulsed Nd:YAG laser has been used for treatment of flat lesions, while interstitial laser photocoagulation by continuous wave (CW) Nd:YAG laser has been used for treatment of bulkier lesions. After 14 months of follow up, both approaches of laser photocoagulation have shown different success rates, as denoted by the regression of the lesions, an overall acceptable cosmetic outcome, and, generally, patients' satisfaction. Within the limitations of the present study, laser photocoagulation has proven to be a promising technique that may be an alternative or additive modality for treatment of multiple cutaneous neurofibromas. It is a minimally invasive, office-based technique that could be used safely and effectively, with a limited rate of complications. Surface laser photocoagulation has proven to be an effective tool for treatment of flat lesions, especially those located in exposed areas, with a favourable cosmetic result, while interstitial laser photocoagulation could be reserved for bulkier lesions, especially those located in non-exposed areas. However, further studies are necessary to refine the procedure, and to confirm the present encouraging findings, especially over a longer period of follow up, as well as to evaluate laser parameters for optimization of the technique.