Early Detection and Treatment of Cutaneous Neurofibromas
Abstract
Neurofibromatosis 1 (NF1) is a disease that can result in significant dysfunction in many organs. This means that the NF1 patients suffer from a wide spectrum of symptoms. The most common symptom, however, cutaneous neurofibromas (cNF) presents in more than 99% of all NF1 patients. cNF are tumors that develop near nerves in the upper skin layers. These tumors first appear and multiply in young men and women during puberty and also during pregnancy, when hormone levels spike. Although the tumors are not malignant, they result in disfiguration and are a source of profound psychosocial burden, low self-esteem, and greatly diminish the patient’s quality of life. Given the prevalence of these tumors, many are shocked and saddened that their treatment has received so little attention. Even worse is that current treatment modalities are backward and archaic, often treated by excision, electrodessication, or burning. While these methods are effective at removing overt cNF, they result in scarring, dyspigmentation, and a marred appearance. Beginning in 1982, pioneers in laser surgery and medicine, Rox Anderson and John Parrish, proposed the idea that, instead of simply using preexisting laser technologies, a better treatment could be achieved if the unique science of the interaction between laser radiation and biological tissues were used to develop lasers for each specific medical condition. Anderson and Parrish applied their ideas to the treatment of birthmarks. At that time, birthmarks often were simply burned off—as cNFs are treated today. They looked at the anatomy of birthmarks, considered the detailed science, and proposed the laser specifications ideally suited to treat these birthmarks without scarring. Within a few years, laser scientists built the lasers Anderson and Parish wanted, and birthmarks could be treated even in young infants. Soon thereafter, Anderson and Parrish’s work was celebrated and described by many as a “laser miracle.” The present proposal describes a similar effort that will lead the way to early detection and effective treatment of cNF without scarring, dyspigmentation, and a marred appearance. Our proposed study has two components. First is the early detection of the fibromas—before they are visible to the naked eye. Next, a noninvasive treatment is proposed to prevent the further development of said fibromas. Unlike the landscape of laser medicine in 1982, there are now a number of lasers and imaging technologies that can be used to detect and to treat various aspects of cNF, making it possible to begin the process immediately. The imaging method, Optical Coherence Tomography (OCT), allows the visualization of minute-sized features inside the skin and will be adapted to detect very small fibromas. As with all tumors, fibromas grow in regions with many blood vessels—regions with abnormally high vascular density. These regions can also be detected using OCT and then eradicated with vascular-targeting lasers, rendering it impossible for the fibromas to grow. Another goal of our research is to study the initial formation of fibromas. Previous studies have shown cNF often form in skin regions such as a hair follicle. The combination of OCT and laser hair removal will be used to investigate how to stop the initiation and development of cNF. The investigators are confident that nearly all NF1 patients will benefit from this research. The results will lead to a treatment that greatly impacts their quality of life. The approach is well rooted in the science of laser tissue interaction, increasing the probability of developing a new, low-risk treatment of cNF. While it is evident that the proposed work will have a marked impact on NF1 patients, the concepts refined and developed in this proposal are applicable to the treatment of other fibromas and tumors.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110379
Entities
People
- Wangcun Jia
Organizations
- United States Army
- University of California, Irvine