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Published on: June 15, 2020
Intralesional laser therapy of extensive hemangiomas in 100 consecutive pediatric patients
F D Burstein1, C Simms, S R Cohen
1The Center for Craniofacial Disorders, Scottish Rite Children's Medical Center, Atlanta, GA 30342, USA.
Insights
Intralesional laser therapy effectively treats pediatric capillary/cavernous hemangiomas, significantly reducing size and improving function. This method often makes previously inoperable lesions safely resectable.
Area of Science:
- Pediatric Dermatology
- Vascular Lesion Treatment
- Laser Therapy
Background:
- Capillary/cavernous hemangiomas are common pediatric vascular tumors.
- Large or complex hemangiomas can cause significant functional impairment and cosmetic concerns.
- Intralesional laser therapy offers a targeted approach to reducing hemangioma size.
Purpose of the Study:
- To evaluate the efficacy and safety of intralesional laser therapy for pediatric capillary/cavernous hemangiomas.
- To assess the impact of laser treatment on lesion size and functional outcomes.
- To compare outcomes between Nd:YAG and KTP laser modalities.
Main Methods:
- A cohort of 100 pediatric patients with capillary/cavernous hemangiomas received intralesional laser treatment.
- Nd:YAG or KTP lasers were used, with follow-up ranging from 6 to 36 months.
- Subsequent treatments included tunable dye laser for superficial components and surgical resection.
Main Results:
- Significant size reduction was achieved in all patients (50-90% in 54, >90% in 46).
- No significant difference was observed between Nd:YAG and KTP laser efficacy.
- Four operative complications occurred, including midfacial weakness and skin burns.
Conclusions:
- Intralesional laser therapy is a valuable treatment for pediatric capillary/cavernous hemangiomas.
- The technique can render inoperable lesions resectable or significantly reduce their size and impact.
- Laser therapy provides a safe and effective option for managing complex vascular lesions.
Abstract:
The authors have treated 100 consecutive pediatric patients with capillary/cavernous hemangiomas (age range, 1.3 months to 16 years; mean age, 26.6 months; 30 male and 70 female patients) with intralesional laser therapy during a 3-year period. All patients have been followed for a minimum of 6 months after treatment (range, 6-36 months; mean, 18 months). Indications for intralesional laser treatment included interference with vision, blockage of the nose or mouth, ulceration, bleeding, and rapid, uncontrollable growth. The Nd:YAG laser was used in 70 patients, and the Potassium, Titanyl, Phosphate (KTP) laser was used in 30 patients. Fifty-five hemangiomas were in the head and neck region, excluding the orbit; 25 were in the trunk or extremities; 10 were periorbital; and 10 involved multiple sites. Seventy patients (70%) received one treatment, 20 patients (20%) received two treatments, 7 patients (7%) received three treatments, and 3 patients (3%) received four or more treatments. No appreciable differences were noted between treatment with the Nd:YAG and KTP lasers. Forty-six patients had more than a 90% reduction in the overall size of the hemangiomas whereas 54 patients had a 50% to 90% reduction in the size of the hemangioma. After maximal reduction in size of the cavernous component was achieved, the external capillary component, found in 68 patients, was treated with a tunable dye laser. Seventy-six patients underwent surgical resection after maximal lesion involution. Residual induration due to lesion fibrosis was treated with local steroid injections in 13 patients. There were four operative complications attributable to intralesional laser therapy. Two patients had residual midfacial weakness, and two patients had punctuated skin burns after intralesional treatment. The authors have found intralesional laser therapy to be a valuable tool in the treatment of large capillary/cavernous hemangiomas, often rendering an inoperable lesion safely resectable, or markedly decreasing the size and functional impact of the lesion.
