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What Is Nodular Fasciitis?

Nodular fasciitis is a fast-growing lump in your soft tissue. It’s not clear why you get it, but it’s not cancerous. It's sometimes called pseudosarcomatous fasciitis, proliferative fasciitis, or infiltrative fasciitis.

It's a noncancerous skin growth in your soft tissue. The term fasciitis refers to inflammation in your fascia. This is the connective tissue just under your skin that holds all your muscles, veins, organs, bones, and nerves in place.

Nodular fasciitis is a lump that can grow into your fascia. The tumors can also grow in places without fascia, including in:

  • Muscles
  • Space in between your muscles
  • Blood vessels
  • Skin

These tumors are rare and benign. They look like cancer and are often misdiagnosed as it.

You can have nodular fasciitis anywhere on your body. The growths are most common in your upper body. They are often found in your:

  • Neck
  • Head
  • Arms
  • Hands
  • Legs
  • Torso

Causes of Nodular Fasciitis

It’s not clear why you get nodular fasciitis. One theory is that a reaction to an injury or infection will cause the tumor to grow. But you can have nodular fasciitis without having an injury.

Some research shows that some genetic changes cause uncontrolled cell growth leading to the lump. More research is needed to understand this connection.

Nodular fasciitis lumps usually grow in people between 20 and 40 years of age. But people of any age can get them.

Symptoms of Nodular Fasciitis

Nodular fasciitis symptoms include a lump that is:

  • Usually small, around 2 cm
  • Fast-growing
  • Solid
  • Rubbery
  • Firm
  • Painless, but can be tender
  • A single mass

Nodular fasciitis doesn’t spread and usually doesn’t hurt unless it starts to press against a nerve or grow in a specific area. A lump on the bottom of your foot could affect how you walk or make shoes uncomfortable. You might have tingling or numbness if it presses against a nerve.

You might not notice you have a growth until it gets big or starts causing other problems. These lumps usually grow fast and will look like cancerous tumors during an examination.

Diagnosing Nodular Fasciitis

Nodular fasciitis is challenging to diagnose. It looks and feels like cancer. Your doctor will take a tissue sample called a biopsy and will test the tissue to look at the types of cells. It often looks like cancer at this level as well.

Nodular fasciitis is also mistaken for:

Your doctor might also use magnetic resonance imaging (MRI). These detailed images can help identify nodular fasciitis.

You should visit your doctor right away if you notice a lump in your skin or tissue, especially if it is:

  • Larger than 5 centimeters
  • Painful to the touch
  • Growing fast

Treatment of Nodular Fasciitis

Your doctor may apply different treatments for nodular fasciitis. Thorough testing to get the right diagnosis will prevent unnecessary treatment.

Observation. Sometimes nodular fasciitis will suddenly get better on its own. This is called spontaneous regression. Your doctor might decide to monitor the lump and see if it will go away, especially if it’s small.

Surgery. This is the most common treatment for nodular fasciitis. Your doctor might do surgery to remove the lump, especially if it’s large. They might not want to operate if you have nodular fasciitis on your face. The surgery can cause scars.

Pinhole laser. This is a less invasive treatment with a carbon dioxide laser. It’s used in a pinhole pattern and can help shrink the lump and the tissue. This is especially helpful for nodular fasciitis on the face because it doesn’t cause scarring. You might need to have several treatments.

Injections. Nodular fasciitis can also be treated with triamcinolone intralesional injections. This is a steroid medication inserted directly into the lump with a needle. You might have to have several injections.

Steroid injections might work better for newer, smaller, and looser lumps. The longer you have nodular fasciitis, the harder the lump can become. This can make it difficult to inject medication into it.

Pinhole laser and steroid injections might work best together. This combination is especially helpful for cosmetic reasons because it causes very minimal scarring. These scars are usually smaller than the lump itself and can be fixed with other skin treatments.

As with any lump, it’s important to have your doctor look at your skin to rule out any other skin conditions.

WebMD Medical Reference

Sources

SOURCES:

The American journal of surgical pathology: “Intradermal nodular fasciitis: a rare lesion analyzed in a series of 24 cases.”

ANNALS of DERMATOLOGY: “Treatment of Nodular Fasciitis Occurring on the Face.”

Cancer Cytopathology: “Nodular fasciitis: A frequent diagnostic pitfall on fine‐needle aspiration.”

INTERNATIONAL JOURNAL OF SURGERY CASE REPORTS: “Nodular fasciitis mimicking a soft tissue sarcoma – A case report,” “Nodular fasciitis of the face: A case report.”

JOHNS HOPKINS: “Muscle Pain: It May Actually Be Your Fascia.”

Military medicine: “Nodular fasciitis: an uncommon disease with common medical management challenges at a remote Naval Hospital.”

Modern pathology: an official journal of the United States and Canadian Academy of Pathology: “USP6 activation in nodular fasciitis by promoter-swapping gene fusions.”

UW Medicine: “Soft Tissue Masses.”

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