Videomicroscopy of Venular Malformations (Port‐Wine Stain Type): Prediction of Response to Pulsed Dye Laser

Abstract

Videomicroscopy has been found to be useful in determining the depth of ectasia of vascular malformations. Different patterns that hypothetically could predict the response of a vascular malformation to pulsed dye laser have been described. Our purpose was to determine if the dermoscopy pattern was able to predict the response to pulsed dye laser therapy and if it was independent of other known clinical variables. Thirty-three consecutive children presenting for evaluation or treatment of vascular malformations underwent videomicroscopy previous to pulsed dye laser therapy. Sixty-nine representative areas were evaluated before and after laser therapy. Other clinical factors, including location of the malformation, the patient's age and sex, and previous therapy, were also included in the analysis. We found that the dermoscopy pattern was differently distributed depending on the anatomic area. A superficial pattern was not present in the centrofacial area. An undefined pattern was most often present when a previously treated area was imaged. A superficial pattern independently predicted a good response to laser. The location of the lesion was another independent factor influencing the outcome. A new pattern consisting of a pale circular area surrounding a central brownish dot is described as negatively influencing the response to laser therapy. We concluded that videomicroscopy is a good tool for assessing which vascular malformations can be adequately treated with laser therapy, although other anatomic factors can influence the response. Videomicroscopy is particularly helpful in deciding when to end the treatment because it objectively shows when no further response can be expected, and is helpful for demonstrating this to patients and their parents.

Dermatoscopy: Alternative uses in daily clinical practice

“…84,85 Another possible finding includes a gray whitish veil, due to the deep dermal distribution of the lesion. 86,87 Two more patterns have been observed. One is characterized by streaks of white linear structures on a variably whitish to blue background.…”

“…Both patterns seem to be predictive of poor laser therapy response. 87 Bowen's disease Dermatoscopy allows a noninvasive evaluation of the entire lesion, compared with incisional biopsy, which provides histologic information only for a limited area. 88 At dermatoscopic examination, Bowen's disease displays atypical vascular structures, with a preponderance of dotted/glomerular vessels, and a scaly surface occurring in up to 90% of cases.…”

Dermoscopy: distinguishing malignant tumors from benign

“…They correspond to superficial ectatic vertical papillary vessels and with deeper ectatic horizontal subpapillary capillaries, respectively [139][140][141].…”

Treatment of pulsed dye laser–resistant port wine stain birthmarks

“…More recently a variety of noninvasive transcutaneous imaging techniques such as laser Doppler imaging, confocal microscopy, photoacoustic probes, and videomicroscopy have been used with varying success to identify dermal morphological vessel characteristics, which may be used to predict treatment response. 4,15 WHY DO MOST PWS NOT CLEAR COMPLETELY WITH PDL AND SOME NOT LIGHTEN AT ALL?…”