Definition & Overview
Cutaneous vascular lesions are the most common paediatric birthmarks. These lesions don’t always have to be removed. However, if they proliferate or grow in number, they can cause some complications. This makes destroying them necessary. Nowadays, this can be done through various types of laser therapy, such as pulsed dye laser and laser ablation therapy, among others.
Who Should Undergo and Expected Results
Patients who have cutaneous vascular lesions that continue to grow in number can undergo various types of laser therapy. If patients do not seek such treatment, it is likely that the lesions will cause complications in the future. Severe complications can include disfigurement, loss of function, or airway obstruction.
Cutaneous vascular proliferative lesions come in many forms. These include:
- Infantile hemangioma – These are the most common vascular lesions that present at birth. Most of them proliferate rapidly within months.
- Port-wine stain birthmarks – These occur in only 0.3% of all newborns, and tend to persist throughout life unless destroyed. They are caused by ectatic capillaries and postcapillary venules. They commonly appear on the head and neck. In some cases, they may cause soft-tissue overgrowth and eventually, some form of disfigurement.
- Arteriovenous malformations – These are caused by abnormal vascular development in foetuses. They form when the arterial and venous systems join without an intermediate capillary bed.
- Kaposi sarcomas – These are caused by the human herpes virus 8 infection or the Kaposi sarcoma herpes virus. The lesions come in macules and papules that form large patches. They are more proliferative than other types of vascular lesions. Some of them are related to immune system deficiencies.
- Angiofibromas – These are lesions that develop among patients with tuberous sclerosis or TS. TS is an autosomal dominant disorder caused by gene defects that cause abnormal blood vessel proliferation in various organs.
- Hemangiomas – These are very common benign lesions that affect 1 to 3 percent of newborns. They come in many forms, from superficial bright red nodules on the skin to bluish nodules with normal skin over them.
Some of these lesions may already be visible at birth. Some, however, only become visible within the first weeks of life. Some of them may be flat, while some are raised. Some may be soft and easily compressible.
The effectiveness of laser therapy in destroying cutaneous vascular proliferative lesions depends on several factors. These include:
- The amount of laser light that reaches the blood vessels - The epidermal melanin absorbs the laser light. This reduces the amount of therapeutic light that reaches the blood vessels. This is especially true for patients with darker skin.
- The size of the blood vessels – Very small superficial blood vessels are very difficult to treat.
- Access to the lesions – Some lesions are surgically inaccessible.
How is the Procedure Performed?
There are currently several techniques that can be used to destroy cutaneous vascular proliferative lesions. These include:
- Topical steroid therapy
- Intralesional steroid therapy
- Laser therapy
- Surgical resection
- Endovascular therapy
- Photodynamic therapy
- Antiangiogenic therapy
Each of these techniques has their advantages and limitations. Of all treatment options, laser therapy is considered the gold standard.
Pulsed dye laser - The most common and most effective laser technique used in destroying superficial lesions is the pulsed dye laser. Patients typically require more than ten sessions to completely treat the condition.
Laser ablation - Patients who suffer from Kaposi sarcoma, however, may see better results with laser ablation.
Aluminium-garnet laser therapy - This is the most ideal treatment for patients with angiofibromas.
Carbon dioxide laser therapy - This is most effective in treating hemangiomas that do not respond to corticosteroids. It is especially helpful for patients with lesions that cause airway obstruction.
Laser is the treatment of choice for the destruction of cutaneous vascular proliferative lesions because it:
- Can penetrate through the outer layers of skin
- Has a low risk of scarring
- Offers targeted therapy
In general, laser therapy is performed by pressing a laser light source against the affected area. This instrument sends laser energy directly to the affected layer of skin tissue. It safely passes through the overlying layers of skin without negative effects. This allows doctors to treat the lesion directly, with a lower risk of affecting nearby tissues.
Possible Risks and Complications
Patients who undergo the procedure are at risk of some potential complications. These include:
- Incomplete resection of the lesion
- Parasitisation of new blood vessels
- Partially damaged blood vessels around the treatment area
- Cardiopulmonary complications
One promising technique to prevent recurrences is to combine laser therapy with antiangiogenic treatment.
Patel AM, Chou EL, Findeiss L, Kelly KM. “The horizon for treating cutaneous vascular lesions.” Semin Cutan Med Surg. 2012 Jun; 31(2): 98-104. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570568
Wirth FA, Lowitt MH. “Diagnosis and treatment of cutaneous vascular lesions.” Am Fam Physician. 1998 Feb 15;57(4): 765-773. http://www.aafp.org/afp/1998/0215/p765.html