Guidance
2 The procedure
2 The procedure
2.1 Indications
2.1.1 Intralesional photocoagulation is a laser treatment for people with congenital abnormalities of the blood vessels of the skin (including haemangiomas, port wine stains and arteriovenous malformations). Often these abnormalities require no treatment because they may resolve spontaneously or cause only mild cosmetic problems.
2.1.2 Laser treatment is often recommended for lesions near the eyes or orifices, or if lesions bleed, ulcerate or become infected. However, external laser treatment of these vascular abnormalities may not be effective because the laser beam does not penetrate far beneath the skin.
2.2 Outline of the procedure
2.2.1 Intralesional photocoagulation involves inserting a laser fibre into the lesion to deliver light deep within it. More than one treatment may be needed.
2.3 Efficacy
2.3.1 The evidence was limited to small case series studies. The largest study, which only included children, reported that after intralesional photocoagulation, 46% (46/100) of patients had a greater than 90% reduction in the size of the lesion, and the other 54% (54/100) had a 50–90% reduction in the size of the lesion. In this study, 76% (76/100) of patients had a subsequent surgical resection and reconstruction. In another study of patients with periorbital haemangiomas, 83% (19/23) of patients had a 50% or greater reduction in the size of the lesion within 8 months. For more details, refer to the Sources of evidence section.
2.3.2 The Specialist Advisors noted that use of the procedure in the UK was very limited.
2.4 Safety
2.4.1 The following complications were reported in the identified studies: ulceration 17% (4/23) to 25% (3/12); continued gradual bleeding requiring surgical control 8% (1/12); scar contracture needing surgical revision 8% (1/12); infection 4% (1/23); residual weakness of branches of the facial nerve 2% (2/100); requirement for transfusion during treatment 2% (2/100); and small burns 2% (2/100). For more details, refer to the Sources of evidence section.
2.4.2 The Specialist Advisors listed the main potential adverse events as ulceration, nerve injury, tissue necrosis, scarring, contracture, and arteriovenous fistula formation.
2.5 Other comments
2.5.1 The commonest outcome measure in the studies was reduction in the size of the lesions. Evidence on other outcome measures, such as function or the need for further treatment, was very limited.
2.5.2 The procedure may sometimes be used as an adjunct to surgery; this can make interpretation of outcomes more difficult.
2.5.3 There is particular uncertainty in the literature about the severity and consequences of ulceration and scarring caused by the procedure.
2.5.4 Facial nerve damage is an important potential complication.
Andrew Dillon
Chief Executive
September 2004