Neurofibromas are benign skin tumors that arise from small to large nerves depending on the subtype of neurofibroma. They are made of nerve fibers, Schwann cells, connective tissue containing fibroblasts extracellular matrix, blood vessels, and mast cells. Although neurofibroma is a common tumor, not everyone with neurofibroma has neurofibromatosis type 1 (a genetic disorder). Neurofibromas can further be divided into diffuse, cutaneous or dermal type, intramuscular and plexiform type. Type 1 neurofibromatosis is mostly related to the plexiform type.(1)
What Is The Best Way To Get Rid Of Neurofibromas?
The removal of neurofibroma should always be done under the guidance of a plastic surgeon that has expertise in removing neurofibromas and dealing with such cases as neurofibromas are different from any other benign tumor or skin tags. The scarring, bleeding, and complications related to neurofibromas can be more serious from other benign lesions and differs from patient to patient. This is because there are different types of neurofibromas and removing some (such as plexiform neurofibroma) may be difficult and may lead to permanent nerve damage or hematoma.(2)
There is no one best technique to remove a neurofibroma as there are different types of neurofibromas and different techniques too. What technique to be utilized in a particular patient depends on the type, location, size, and a number of neurofibromas and also involves the expertise and preference of a particular doctor. The classical approach of removing a neurofibroma is surgical excision of the tumor. A small tumor or few numbers of neurofibromas can be removed by surgically excising the tumors with a scalpel or can use electrosurgery to destroy the tumors instead of excising it. A larger tumor may be only surgically excised and closed making electrosurgery impractical in such a case. Furthermore, treating hundreds of cutaneous neurofibromas with surgical excision may be impractical, in which case combination of excision and electrosurgery may be needed. Other techniques that may be utilized for the management of neurofibroma include laser surgery, cryosurgery, and chemosurgery along with surgical curettement.(2)
The popular electrosurgical technique utilized in the management of neurofibroma is electrodesiccation that uses electrical current to dehydrate the tissue and cauterize it. It is used to treat hundreds of neurofibromas at a time. The superficial tumors can be treated with fulguration and electrocoagulation. Although the best option for deeper lesions is surgical excision, it is sometimes not practical. Complete surgical excision of some deeper neurofibromas is not possible that are infiltrative and extend down to the fat layers, these tumors can only be removed partially to improve the skin contour. Since some tumors cannot be completed removed or destroyed either with surgical excision or electrodesiccation, there are greater chances of recurrence in these cases and retreatment may be mandated.(2)
Types Of Neurofibroma
The most common type of neurofibroma is cutaneous or dermal type, rest all other types are relatively uncommon tumors. They are usually seen as lumps or bumps on the skin in teens and young adults. Cutaneous tumors have well-defined borders making them easy to surgically excise. The number of lesions varies from patient to patient and can range from single to hundreds of lesions. Usually, large numbers of lesions are seen in individuals with a family history of neurofibroma.(1)
Diffuse and plexiform neurofibromas are usually seen in children and they rarely occur in adult life. Diffuse neurofibromas affect the skin and do not involve the deeper layer and are more commonly seen in the scalp area; however, they are difficult to treat as they do not have well-defined borders. Plexiform neurofibroma is associated with type 1 neurofibromatosis and in 9% cases undergoes malignant transformation. It mostly affects the larger nerves, but can also involve smaller nerves. Plexiform type can be either nodular or spread diffusely along a nerve. It affects deeper layers and has a tendency to lead to nerve tortuosity making their excision relatively difficult without injuring the involved nerve.(1)