Introduction

Nodular fasciitis is a rare, benign (non-cancerous) condition involving a rapidly developing lump or mass in the connective tissue beneath the skin.¹ While it can be alarming due to its sudden appearance and growth, it is not harmful and does not spread to other parts of the body.

Understanding the treatment options for nodular fasciitis is important for several reasons. For instance, knowing the available treatments can help patients and their families make informed decisions about their care and it can help alleviate the anxiety that often comes with the diagnosis of a rapidly growing mass.

What is nodular fasciitis?

Pathophysiology

Nodular fasciitis is a benign, non-cancerous condition that involves the rapid growth of cells in the fascia, the connective tissue just beneath the skin. The growth often occurs suddenly and can lead to the formation of lumps or masses. The exact cause is not well understood, but it is believed to result from a reaction to minor trauma or injury. Unlike cancerous tumours, nodular fasciitis does not spread to other parts of the body.

Common symptoms

The primary symptom of nodular fasciitis is the appearance of a lump or mass, which can be alarming due to its rapid growth. The common characteristics of this condition include:

• Rapid growth: The lump can develop quickly over a few days or weeks
• Location: It often appears on the arms, legs, or trunk, but can occur anywhere on the body²
• Texture: The lump typically feels firm or rubbery
• Pain: The lump may be tender or painful, particularly when touched or pressed²
• Size: The lump usually measures 2-3cm in diameter but can vary

Diagnosis

Clinical examination

• Physical examination: A doctor will begin by examining the lump and asking about the patient's medical history and any recent injuries. They will assess the size, texture, and mobility of the lump²
• The doctor will inquire about any pain, the duration of the lump's presence, and any changes in size or shape

Imaging techniques

• Ultrasound: This imaging test uses sound waves to create a picture of the lump. It helps to determine the size, shape, and consistency of the mass²
• Magnetic resonance imaging (MRI): An MRI provides detailed images of the soft tissues and is useful in distinguishing nodular fasciitis from other conditions

Computed tomography (CT) scan

A CT scan can also be used to get a detailed view of the lump and its relation to surrounding structures.² Biopsy and microscopic examination:

• Needle biopsy: A small sample of the lump is taken from the body with a needle, usually with local anaesthesia²
• Surgical biopsy: Sometimes, a larger sample or the whole lump is removed for testing
• Microscopic examination: A pathologist looks at the sample under a microscope. Nodular fasciitis typically shows a mix of spindle-shaped cells, gel-like areas, and inflammation

Treatment options

Sometimes, nodular fasciitis can resolve on its own without treatment. In these cases, doctors might recommend simply observing the lump over time. This approach is chosen when either the lump is not causing significant pain or discomfort, or it is not growing rapidly, or there is no impact on the function of the affected area.

Surgical intervention

If the lump is causing symptoms or if there is uncertainty about the diagnosis, surgery may be recommended. Surgical options include:

Excision

• The entire lump is removed³
• This is a common and effective treatment, especially when the lump is causing discomfort or concern³
• The procedure is typically done under local or general anaesthesia, depending on the size and location of the lump³

Curettage

• Involves scraping out the lump³
• May be used for smaller or more superficial lumps³
• Done under local or general anaesthesia³

Non-surgical treatments

For those who prefer not to have surgery or when surgery is not advisable, non-surgical treatments can be considered.

Corticosteroid injections

• Mechanism of action: Steroids help reduce inflammation and can shrink the lump
• Administration: Injected directly into the lump
• These injections can be effective, but potential side effects include skin thinning and changes in pigmentation at the injection site

Pharmacological therapies

• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Help reduce pain and inflammation

When nodular fasciitis is confirmed and there is no risk of cancer, doctors may choose a nonsurgical treatment. If the lump returns after surgery, a special method called Transarterial Interstitial Laser Irradiation (TA ILI) is used. This involves using a CO2 laser to make tiny holes in the lump every 4 weeks. Before the treatment, a cream to numb the skin is applied. The laser creates small holes in the lump, which helps reduce it. This treatment is generally not too painful, and any redness goes away on its own.3

Prognosis and follow-up

The prognosis for nodular fasciitis is generally positive as it is a benign condition that typically responds well to treatment. Most patients experience complete resolution of the lump, and the condition rarely recurs after effective treatment. However, regular follow-up visits with a doctor are essential to monitor the lump and ensure it does not return. During these visits, the doctor will check for any new growth, changes in size, or other symptoms that might indicate a recurrence. Patients need to report any changes or discomfort to their doctor promptly. Following post-treatment care instructions is also crucial for proper healing and to minimize the risk of complications. Regular monitoring and communication with healthcare providers help ensure the best possible outcome for patients with nodular fasciitis.

FAQs

What is nodular fasciitis? 

Nodular fasciitis is a benign, non-cancerous growth that develops rapidly under the skin. It often appears suddenly and can cause a firm, sometimes painful lump, but it does not spread to other parts of the body.

How is nodular fasciitis diagnosed? 

Diagnosis typically involves a physical exam, imaging tests like ultrasound or MRI, and a biopsy. A small tissue sample from the lump is examined under a microscope to confirm it is nodular fasciitis and not another condition.

What are the treatment options for nodular fasciitis? 

Treatment options include:

• Observation: Simply monitoring the lump over time if it is not causing problems
• Surgery: Removing the lump entirely if it is bothersome or growing
• Corticosteroid injections: Reducing the lump’s size with steroid injections
• Medications: Using pain relievers and anti-inflammatory drugs to manage symptoms

When is surgery recommended for nodular fasciitis? 

Surgery is recommended if the lump is causing pain, discomfort, or functional issues, or if there is uncertainty about the diagnosis. It involves removing the lump entirely, usually under local or general anaesthesia.

Can nodular fasciitis go away on its own? 

In some cases, nodular fasciitis can resolve on its own without treatment. If the lump is not causing significant symptoms, doctors may suggest monitoring it to see if it shrinks or disappears over time.

What is the prognosis for nodular fasciitis? 

The prognosis is generally positive. Nodular fasciitis is benign and often resolves with treatment. Recurrence is rare, and regular follow-up visits help ensure any changes are diagnosed early.

What should I do if the lump comes back after treatment? 

If the lump returns after treatment, contact your doctor. They may recommend further evaluation and additional treatments, such as repeated corticosteroid injections or another surgical procedure.

Summary

Nodular fasciitis is a harmless but fast-growing lump that forms under the skin. It often appears suddenly and can cause alarm, but it is not cancer and does not spread to other parts of the body. Common symptoms include a quickly growing, firm, and sometimes painful lump, usually found on the arms, legs, or torso.

Diagnosis involves a physical exam, imaging tests like ultrasound or MRI, and a biopsy to confirm it is nodular fasciitis. Treatment options vary. Doctors may recommend observing the lump, especially if it's not causing problems and if needed, will recommend surgery to remove the lump completely. Non-surgical treatments can also be suggested, which include corticosteroid injections to shrink the lump and medications to manage pain and inflammation.

Emerging treatments like cryotherapy and laser therapy are also being explored. The choice of treatment depends on factors like the lump's size, location, and the patient's preferences.

The prognosis is good, as nodular fasciitis often resolves with treatment and recurrence is rare. Regular follow-up visits are important to monitor the lump and catch any changes early. Patients should report new growth or symptoms to their doctor and follow post-treatment care instructions to ensure proper healing. Regular check-ups help ensure the best outcomes.