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Evolving trends in the treatment of vascular birthmarks

September 19, 2005

The September/October issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals, contains several articles on the current state of knowledge and experience with vascular birthmarks, which are caused by blood vessels that do not form correctly. Vascular birthmarks can be internal, or form an external birthmark and can be disfiguring, especially if formed on the face. In an editorial accompanying the articles, Marcelo Hochman, M.D., of The Facial Surgery Center, Charleston, S.C., writes that more than 400,000 infants in the United States are born with a vascular lesion, including hemangiomas (which include “strawberry” or “raspberry” marks and port wine stains) and various malformations.

“The gap between the perpetuated beliefs about these lesions (‘Lleave it alone; it will go away’) and the current state of our knowledge and experience is very wide,” Dr. Hochman writes. “By disseminating the various viewpoints in this issue we hope to slowly help bridge that gap. Our patients will continue to benefit from the advances in management espoused by the authors until a consensus about treatment is eventually reached.”

In Description and Analysis of Treatments for Port-wine Stain Birthmarks, Kristen M. Kelly, M.D., of the University of California at Irvine, and colleagues present the current treatment approaches for port-wine stains using pulse-dye laser therapy, which currently offers the most effective treatment, the authors suggest, with its ability to selectively target blood vessels.

Rami K. Batniji, M.D., of the Albany Medical College, Albany, N.Y., and colleagues present an algorithmic approach to the management of facial hemangiomas in An Aesthetic Approach to Facial Hemangiomas. They review the natural course, classification and history of treatment of these lesions throughout the past 100 years. Observation may be all that is necessary for stable lesions, the authors suggest, but superficial lesions that are growing rapidly, ulcerating or functionally limiting may require intervention with pulsed laser therapy; deep lesions may require treatment with corticosteroids; and involuting (rolling inward) hemangiomas may require surgery.

Vascular malformation of the head and neck may cause not only significant cosmetic defects but also functional impairment of structures such as the eye, tongue or throat, John P. Deveikis, M.D., of the Medical University of South Carolina, Charleston, reports in Percutaneous Ethanol Sclerotherapy for Vascular Malformations in the Head and Neck. Although surgical treatment is traditionally recommended, Dr. Deveikis suggests that the benefits of surgery may be limited when healthy structures are intimately involved with the lesion. In the article, he presents a study on the evaluation and treatment of patients with vascular malformations of the head and neck using an alternative, minimally invasive treatment.

In Management of Nasal Hemangiomas, Marcelo Hochman, M.D., of The Facial Surgery Center, Charleston, S.C., and Alfredo Mascareno, M.D., an International Visiting Fellow, Guadalajara, Mexico, report their extensive experience treating infantile hemangiomas involving the nose. They present a comprehensive review of the management of these lesions.

Two short articles, Current Knowledge of the Pathogenesis of Infantile Hemangiomas and Hemangiomas of Infancy present the current understanding of the natural course of infantile hemangiomas, the most common benign tumor of infancy, review the common characteristics of ulcerated infantile hemangiomas and discuss treatment options.

Finally, in Congenital Hemangiomas, Alfons Krol, M.D., F.R.C.P.C., and Carol J. MacArthur, M.D., of the Oregon Health and Science University, Portland, describe congenital hemangiomas, much more rare and only recently described hemangiomas, as they differ from infantile hemangiomas in their presentation, natural history and treatment. Juan Carlos Lopez-Guiterrez, M.D., and colleagues from the University of Madrid, Spain, provide a case study of in Giant Rapidly Involuting Congenital Hemangioma of the Face of a rare congenital hemangioma with a 15-year follow-up.

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