Treatment of superficial benign vascular tumors by high intensity focused ultrasound: Observations in two illustrative cases

Abstract

Background Existing therapeutic methods for reduction or removal of superficial vascular malformations and tumors have high risks of scarring and other complications that result in aesthetic appearance less favorable than the baseline. Patients are often cautioned against intervention, which can lead to psychosocial problems and low self‐esteem. Improved treatment modalities are therefore relevant from both medical and aesthetic perspectives. Methods Two volunteer subjects were treated with a medical 20 MHz high intensity focused ultrasound device developed for dermatological conditions. One patient was given three treatments to remove a superficial congenital hemangioma on the left middle cheek. The other patient was given a single treatment to remove seven cherry angiomas on the thighs. Handpieces with nominal focal depths of 0.8 – 1.8 mm below the skin surface were used to administer acoustic energy of 1.1 – 1.2 J/dose. An integrated dermoscope in the handpiece was used to monitor the treatment in real‐time. Results During treatment, blood in the capillary network of the lesions was coagulated immediately, and capillary walls were collapsed due to the thermal and mechanical effects of the high intensity focused ultrasound. During the healing phase, the areas regenerated a normal skin structure with very limited scar or dyspigmentation. At follow‐up, a clear aesthetic improvement was observed over the baseline for all treated targets with the exception of two cherry angiomas, where focal depth and/or dose coverage had not been optimal. Conclusion High intensity focused ultrasound is concluded to be a safe and efficient skin treatment for benign superficial vascular malformations and tumors.

Lead-Free HIFU Transducers

“…However, very similar devices operating from 3 to 10 MHz can be applied for subcutaneous treatments in cosmetology or treatment of shallow organs such as lymph nodes (Zawada and Bove 2017;Bove et al 2019). Use of the same overall design concept, but with a piezoelectric element designed for operating at frequencies of 10 to 25 MHz, can be directly applicable to a very wide range of dermatological indications including actinic keratosis and basal cell carcinoma (Serup et al 2020), seborrheic keratosis (Calik et al 2022), superficial vascular tumors (Calik et al 2021) and verruca vulgaris (Bove et al 2021). Similarly, comparable lead-free transducers operating at lower frequencies, for example, 500 kHz to 2 MHz, allow for deeper ultrasound penetration and larger focal zone sizes (Bove et al 2019).…”

Treatment of Cutaneous Neurofibromas in Patients with Neurofibromatosis Type 1

“…The treatment is performed in a clinically simple procedure, where each individual cNF is covered by HIFU doses, in a session taking approximately 1 min per tumor. The treatment is thus performed with very similar methodology, dosing, and duration compared to previously reported cases on a range of other common dermatological lesions treated by HIFU [7][8][9][10][11][12].…”

“…The device has earlier been demonstrated to provide safe and efficient treatment of other dermatological conditions, including basal cell carcinoma and Kaposi’s sarcoma [7], actinic keratosis [7, 8], seborrheic keratosis [9], superficial vascular tumors [10], and various papillomavirus [11, 12]. Pain levels have been reported to be tolerable without anesthetics, typically with a pain score around 3–6 on a 0–10 numerical rating scale.…”

Treatment of Condylomata Acuminata Using a New Non-Vapor-Generating Focused Ultrasound Method following Imiquimod 5% Cream

“…This device can be used to target features near the surface of the skin, and reproducibly deliver a clinically efficient thermal and mechanical insult with localized heating to approximately 60–65°C that will spontaneously kill cells and denaturate fibrous tissue. The system has earlier been demonstrated to provide safe and efficient treatment of other dermatological indications, including basal cell carcinoma and Kaposi sarcoma [ 9 ], actinic keratosis [ 9 , 10 ], seborrheic keratosis [ 11 ], superficial vascular tumors [ 12 ], and verruca vulgaris [ 13 ].…”

“…Results from prior treatments indicate that virus infected cells are removed directly in the wound crust, and that the healing process furthermore may induce a wider beneficial immune response in the directly adjacent/deeper nontreated tissue [ 9 , 13 ]. Sequelae have been very limited, and only sporadic cases with further fibrous change of an already damaged dermis have been observed [ 9 , 10 , 11 , 12 , 13 ].…”