Squeeze and pop technique for excision of cutaneous neurofibromas

Aravind Sivakumar; Akshay Meena; Newshree Rout; Sheetanshu Kumar

doi:10.25259/CSDM_136_2025

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Innovations

2025

:5;

92

doi:

10.25259/CSDM_136_2025

Squeeze and pop technique for excision of cutaneous neurofibromas

Aravind Sivakumar¹, Akshay Meena¹, Newshree Rout¹, Sheetanshu Kumar^1,

1Department of Dermatology and Sexually Transmitted Disease, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

*Corresponding author: Sheetanshu Kumar, Department of Dermatology and Sexually Transmitted Disease, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. kumarsheetanshu@gmail.com

Received: 2025-07-29, Accepted: 2025-08-05, Published: 2025-09-11

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Sivakumar A, Meena A, Rout N, Kumar S. Squeeze and pop technique for excision of cutaneous neurofibromas. CosmoDerma. 2025;5:92. doi: 10.25259/CSDM_136_2025

PROBLEM

Neurofibromatosis type 1 is an autosomal dominant genodermatosis marked by multiple cutaneous neurofibromas. These tumors can be disfiguring, painful, and may lead to malignancy, impacting quality of life. Treatment includes surgical excision, ablative lasers, photocoagulation, and radiofrequency ablation. Simple elliptical excision is commonly used but often results in larger scars and suboptimal esthetic outcomes.^[1] A shave excision combined with dermal debulking has been described for neurofibromas under 2 cm, though it may lead to incomplete tumor removal, leading to recurrence, excess skin removal, and scarring.^[2] We propose an alternative technique for dermal neurofibromas that offers complete removal with a smaller incision and better esthetic outcomes.

SOLUTION

Local anesthesia is infiltrated around the tumor to achieve hydro-dissection, facilitating the separation of the surrounding tissue from the tumor. A linear incision is made along the tumor’s long axis, followed by undermining of the lesion from surrounding tissue. The tumor is then gently squeezed out using lateral pressure, helping it pop out [Figure 1a and b, Supplementary Video 1]. The deep dermal tail is dissected, and the tumor is completely removed. Any excess skin is trimmed or used as a flap to cover the defect. The tumor’s soft consistency and loose surrounding tissue make this technique ideal for neurofibroma excision. This method ensures complete tumor removal, reduces recurrence risk, minimizes defects, lowers wound tension, and improves cosmetic outcomes with less scarring and pigmentation.

Supplementary Video 1.

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(a and b) Extrusion of tumor bulk using the squeeze and pop technique.

Ethical approval:

Institutional review board approval is not required.

Declaration of patient consent:

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest:

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation:

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship: Nil.

References

Chamseddin BH, Le LQ. Management of cutaneous neurofibroma: Current therapy and future directions. Neurooncol Adv. 2020;2:i107-16.
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