Treatment of Haemangiomas and Vascular Malformations with the Neodymium-YAG Laser - Strategy and Results in over 2000 Cases

Background: Haemangiomas represent the most common type of benign vascular tumours in childhood. A proliferative phase of unknown duration and extent is followed by an involutional period, which passes into regression in approximately 70% of all cases. A multitude of different treatment options, such as corticosteroids, cryotherapy, laser, sclerotherapy, radiotherapy and surgical methods have been published. Due to the high rate of spontaneous regression, many authors advise not to undertake any treatment. The dilemma of this "wait and see" approach constitutes those cases in which sudden and pronounced growth is not followed by complete regression with possible severe aesthetic and functional impairment. To avoid this dilemma, a specific algorithm for the treatment of haernangiomas was instituted at our department, based essentially on early laser treatment when relevant growth is present. Patients and Methods: More than 2000 patients with haemangiomas as well as vascular malformations have been treated at our department in the last 16 years. An algorithm for treatment of these disorders is presented. Results: All therapeutic procedures, especially direct neodymium-YAG laser treatment with either contact cooling or intralesional, is described and postinterventional results are presented. Conclusion: Early laser treatment of fast grooving haemangiomas prevents uncontrolled proliferation of these childhood tumours and, in our experience, represents a definite improvement of long-term results when compared to the "wait and see" method.