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Management of vascular birthmarks: review of a multidisciplinary clinic
1Our Lady's Hospital for Sick Children, Crumlin, Dublin.
Insights
Accurate diagnosis of vascular birthmarks is crucial for effective treatment. Specialized clinics are essential, as many diagnoses are incorrect, especially for vascular malformations.
Area of Science:
- Dermatology
- Pediatric Surgery
- Medical Genetics
Background:
- Vascular birthmarks are congenital lesions with varied presentations, posing diagnostic and management challenges.
- Accurate diagnosis is vital for appropriate, individualized treatment plans to achieve optimal outcomes.
- While primary physicians manage simple cases, complex lesions necessitate specialized multidisciplinary care.
Purpose of the Study:
- To review the diagnostic accuracy and management of vascular anomalies at a specialized multidisciplinary clinic.
- To highlight the challenges in diagnosing diverse vascular birthmarks and their associated conditions.
Main Methods:
- Retrospective review of patients attending a Joint Vascular Birthmark Clinic (JVBC).
- Analysis of initial diagnoses versus final diagnoses within the specialized clinic setting.
- Categorization of lesions into vascular tumors and malformations.
Main Results:
- Vascular tumors comprised 57% and malformations 43% of reviewed cases.
- 42% of patients had an incorrect initial or referring diagnosis.
- A significant 62% of vascular malformations were misdiagnosed, underscoring the need for expert evaluation.
Conclusions:
- Specialized multidisciplinary clinics are critical for accurate diagnosis and management of complex vascular birthmarks.
- High rates of diagnostic errors emphasize the limitations of non-specialized evaluations for these conditions.
Abstract:
Vascular birthmarks comprise a diverse group of congenital lesions and represent a significant cosmetic and functional burden for patients. They remain a diagnostic and management challenge for physicians due to their extremely variable clinical presentation and often complex anatomical associations. As each type of vascular lesion has a treatment program individual to it, optimal functional and cosmetic outcomes require accurate diagnosis. Primary physicians readily diagnose and manage uncomplicated lesions, such as isolated haemangiomas and innocuous capillary malformations. However, given the complexity and relative rarity of many other vascular birthmarks, specialised multidisciplinary clinics are central to their management. In this review, we present our experience regarding the diagnostic range of vascular anomalies, associated symptomatology, and management of patients with vascular birthmarks attending the multidisciplinary Joint Vascular Birthmark Clinic at Our Lady's Children's Hospital, Crumlin. Vascular tumours represented 57% of cases reviewed, malformations accounting for 43%. Of patients not previously seen at the JVBC or by any of the individual consultants, the initial or referring diagnosis was incorrect in 42%. Significantly, 62% of vascular malformations were assigned an incorrect diagnosis, highlighting the need for a specialised clinic.
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