Ann Dermatol.  2015 Dec;27(6):694-701. 10.5021/ad.2015.27.6.694.

Treatment of Nodular Fasciitis Occurring on the Face

• Oh BH
• Kim J
• Zheng Z
• Roh MR
• Chung KY

• KMID: 2157445
• DOI: http://doi.org/10.5021/ad.2015.27.6.694

Abstract

BACKGROUND
Surgical 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.
OBJECTIVE
To describe our experience with NF occurring on the face and evaluate the outcomes of surgical and nonsurgical methods of treatment.
METHODS
We 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.
RESULTS
Among 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.
CONCLUSION
Surgical 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.

Keyword

Intralesional injection; Laser therapy; Nodular fasciitis

MeSH Terms

Carbon Dioxide
Cicatrix
Fasciitis*
Hand
Humans
Injections, Intralesional
Laser Therapy
Recurrence
Retrospective Studies
Sarcoma
Triamcinolone
Carbon Dioxide
Triamcinolone

Figure

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  Fig. 1 Nonsurgical treatment with a pinhole method with a CO2 laser.

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  Fig. 2 (A) Benign fibroblastic proliferation in subcutaneous areas around facial muscle, which are mostly composed of epithelioid and spindle cells (H&E stain, ×40). (B) Loose myxoid structure observed on higher magnification (H&E stain, ×100).

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  Fig. 3 Flow chart of the treatment outcome. TA ILI: triamcinolone intralesional injection.

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  Fig. 4 Serial photographs of a representative patient (case no. 2) treated with the surgical approach. (A) A coin-sized, skin-colored, deep-seated nodule that recurred on the right zygomatic area. (B) The recurrent lesion was completely removed with Mohs micrographic surgery. (C) Reconstruction was done by using a rhombic flap. (D) Surgical treatment eventually resulted in scarring after 3 months.

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  Fig. 5 Serial photographs of representative patients treated with the nonsurgical approach. (A) A beansized, brown nodule on the nose (case no. 13). (B) Three months later, after three sessions of pinhole laser treatment and triamcinolone intralesional injection (TA ILI). (C) A bean-sized, erythematous, dome-shaped nodule on the nose (case no. 14). (D) Three months later, after three sessions of pinhole laser treatment and TA ILI.

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