Lasers in Medical Science

https://doi.org/10.1007/s10103-020-03058-3

REVIEW ARTICLE

Cutaneous vascular lesions in the pediatric population: a review

of laser surgery applications and lesion-specific device parameters
Thomas Vazquez 1,2,3 & Mahtab Forouzandeh 2 & Pooja Gurnani 1,2 & Shifa Akhtar 1 & Keyvan Nouri 2

Received: 2 February 2020 / Accepted: 1 June 2020

# Springer-Verlag London Ltd., part of Springer Nature 2020

Abstract
Laser surgery is becoming an increasingly efficacious and customizable treatment modality for the management of pediatric
vascular lesions. Proper use requires a thorough understanding of the scientific principles of laser surgery and knowledge of the
various lasers available. Moreover, each laser has a multitude of settings that can be employed to properly target the lesion at
hand. Each patient will present with unique challenges and variations in the presentation of their vascular lesion. This requires
understanding of the most effective laser to use for each lesion and the factors that may alter the desired device settings. Using key
search terms, a literature search was conducted on laser surgery for pediatric vascular lesions using PubMed/MEDLINE and
Embase for articles published in English or French. Ultimately, 52 articles met our search criteria. The laser indications,
limitations, and settings utilized for each type of vascular lesion were compiled for the purposes of this summative review.
Laser surgery is an effective and appropriate option for the treatment of certain pediatric vascular lesions. Knowledge of optimal
device parameters in every setting is essential to good clinical practice.

Keywords Pediatric . Dermatology . Vascular tumor . Vascular malformation . Laser . Laser surgery

Introduction development. An individualized approach to these vascular

The management of vascular lesions in the pediatric popula-
tion can become complex, requiring an interdisciplinary ap-
proach and meticulous treatment considerations. Among the
treatment modalities available, laser surgery has gained rec-
ognition as an effective and minimally invasive treatment op-
tion in the management of pediatric vascular lesions.
Accordingly, it is important that dermatologists who are
treating vascular lesions in the pediatric population are aware
of the multiple laser options available to them and their re-
spective indications, limitations, and recommended device pa-
rameters. There is a wide variety of distinct vascular lesions,
and each kind of lesion may present during different stages of
lesions requires careful consideration of many factors such
as age, Fitzpatrick skin type, lesion type, location, depth,
and clinical progression. Consideration of all of these factors
will aid in the selection of the appropriate laser and corre-
sponding device parameters, such as wavelength, pulse dura-
tion, fluence, and spot size, as well as the recommended num-
ber of treatment sessions.
This review aims to guide clinical practice by providing
dermatologists with an outline of the laser options available
to them in the treatment of various types of pediatric vascular
lesions, with special attention given to laser indications, de-
vice settings, and limitations seen with each type of lesion,
according to the current literature.

* Thomas Vazquez
tvazq020@med.fiu.edu Methods
1
Wertheim College of Medicine, Florida International University, A literature search of PubMed/MEDLINE and Embase was
Miami, FL, USA conducted using key search terms, including “pediatrics
2
Department of Dermatology and Cutaneous Surgery, University of [Mesh],” “skin abnormalities [Mesh],” “vascular,” “lasers/
Miami Miller School of Medicine, Miami, FL, USA therapeutic use [Mesh],” “lasers/utilization [Mesh],” “lasers
3
Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave., 2nd [Mesh],” “hemangioma,” port wine stain,” “glomuvenous,”
Floor, Unit 2099, Miami, FL 33136, USA and “blue rubber bleb nevus syndrome.” “Blue rubber bleb

nevus syndrome” and “glomuvenous” were included as
search terms due to their underrepresentation in the prelimi-
nary search results. Our search was limited to articles in
English and French published between 1988 and 2018, yield-
ing 205 results. Every manuscript published in English and
French was comprehensively screened for inclusion.
Manuscripts that included the pediatric population and the
use of laser surgery for any type of vascular lesion were in-
cluded in this review. Several older articles were included due
to the lack of recent developments in the laser treatment of
certain lesions. Moreover, some of these earlier studies con-
tain more extensive information regarding the associated ad-
verse effects. All article types were included due to the relative
lack of randomized trials on this topic. Articles that lacked
clear outcomes, failed to explain the laser technique used, or
that recommended outdated treatment modalities were exclud-
ed. Manuscripts that focused on non-cutaneous vascular le-
sions (i.e., oral, respiratory, gastrointestinal, and vaginal) were
excluded. Manuscripts focusing on interstitial or endovenous
laser therapy were also excluded. Ultimately, 52 articles met
our search criteria. The specific laser indications, limitations,
and settings utilized in each manuscript were recorded, along
with their reported outcomes. When several, similar laser set-
tings for one type of lesion were employed, the settings are
reported as a range (Table 1).
Results
Infantile hemangiomas
Infantile hemangiomas (IH) are the most common pediatric
tumor and are frequently treated conservatively with a wait-
and-watch mentality [1–3]. The American Academy of
Pediatrics Clinical Practice Guidelines for the Management
of Infantile Hemangiomas currently classifies laser surgery
as a grade C, moderate recommendation [4]. IH appear in
infants and never re-appear later in life [5]. Slaughter et al.
elaborate on a detailed treatment algorithm describing the ap-
proach and treatment of choice for IH in various locations and
stages of evolution [3]. The most commonly utilized treat-
ments for IH are propranolol or topical timolol, intralesional
steroids, lasers, and surgical excision [5–8]. Studies that com-
pare PDL surgery to β-blockers and combination therapy
demonstrated greater efficacy with combination therapy than
β-blocker monotherapy [9]. Although many IH regress with
age, there are cases where management should be more asser-
tive [10]. IH with ulcerations or in high-risk areas such as the
eyelid and ear should be managed more aggressively; howev-
er, IH should be assessed long before ulceration occurs [1, 10].
In addition to the risk for ocular occlusion, IH on the eyelid (as
well as the nasal tip) display an unpredictable clinical course
and should be monitored closely for the potential need for
Lasers Med Sci
intervention [10, 11]. It should be noted that 25 to 40% of
conservatively managed facial IH result in esthetically
displeasing results [3].
Both PDL and the neodymium-doped yttrium aluminum
garnet (Nd:YAG) laser have been shown to be efficacious
for treating IH. Laser therapy of IH is most commonly used
for ulcerated IH refractory to medication as well as for residual
telangiectasias or scarring after primary treatment or involu-
tion [12–16]. In patients who elect to undergo medical therapy
first, PDL can be an efficacious adjuvant therapy. In one
study, 75% of patients who were refractory to propranolol
were treated secondarily with PDL [1]. The treatment param-
eters for PDL typically are 595 nm, 6 to 9 J/cm2, 1.5 ms, and
10-mm spot size, with epidermal dynamic cooling.
Furthermore, selection of the most appropriate energy density
should be based on the patient’s purpuric threshold [2, 3, 10,
17]. Alternatively, Dementieva and Jones attempted to reduce
IH color and volume after treatment with propranolol with
moderate success using a diode laser (940 nm, 450 to 500
Dg/cm2, 10 to 100 ms pulse duration, 500 ms between pulses
and pulse mode) [14].
PDL is often the laser of choice for the treatment of IH and
is indicated frequently for telangiectasias and fibrofatty resid-
uum, after natural involution, to aid in the healing of involut-
ing IH and for ulcerated IH [2–4, 9, 17]. There is a general
consensus that IH should be managed in their early macular
phase when they are most amenable to therapy [2, 10]. Burns
et al. restrict their treatment of IH with PDL to the early flat,
macular phase, which is superficial enough for PDL to be
effective. PDL has a maximum depth of penetration of
1.2 mm [13]. Energy penetration varies depending on laser
parameters including wavelength, pulse duration, fluence,
spot size, and epidermal cooling system [17–21].
In a 2002 randomized controlled trial by Batta et al., 121
infants with superficial early uncomplicated hemangiomas
were treated with biweekly PDL (585 nm, 6.0–7.5 /cm2,
0.45 ms, 3- to 5-mm spot size) versus a wait-and-see approach
[22]. Their data showed no difference in complete clearance or
minimal residual signs between the two groups at 1 year (p =
0.92). Subjects in the treatment arm did demonstrate reduced
redness at 1 year (p = 0.002). Thirteen percent of children in
the treatment group experienced subjective, parent reported
discomfort for 2–4 days after treatment, and crusting was ob-
served in 32% of children. Similar rates of hypopigmentation
and atrophy were seen in both groups.
Burns et al. concluded in their review that Nd:YAG
(1064 nm, 80 J/cm2, 50 ms, 6-mm spot size) pulses should
be spaced 2 to 6 mm apart. Moreover, they stress the impor-
tance of dermal cooling in conjunction with laser treatment to
minimize the risk of skin atrophy and hypopigmentation [18].
It is recommended that growing IH be treated every 2 to
3 weeks and quiescent IH be treated every 4 to 6 weeks [2,
3, 19]. Nd:YAG therapy is also indicated in periocular IH
Lasers Med Sci

Table 1 Current laser techniques for pediatric vascular lesions

Lesion type (n. of references) Laser type Wavelength Fluence Pulse duration Spot size Notes

Infantile hemangioma (26) Diode Laser 940 nm 450–500 Dg/cm2 10–100 ms Pulse mode
PDL 595 nm 6–9 J/cm2 0.45–3 ms 3–10 mm With epidermal dynamic cooling,
every 2–3 weeks for growing
IH and 4–6 weeks for quiescent
IH1, 5–7 treatments2
Nd:YAG 1064 nm 80 J/cm2 50 ms 3–4 mm Pulses spaced 2 to 6 mm apart
Telangiectasia (3) PDL or KTP 595/532 nm 9.5–11 J/cm2 1.5 ms 5–7 mm Dynamic cooling, wavelength not
reported, only 1 treatment
typically required
Pyogenic granuloma (5) PDL 585 nm 6–14 J/cm2 0.45–3 ms 5–7 mm With dynamic cooling, every
2–4 weeks2
Nd:YAG3 120–165 J/cm2 10–80 ms 3 mm
Port wine stains (15) PDL 585–595 nm 4.8–8 J/cm2 0.45–1.5 ms Every 2–3 months, 6 sessions
have also been used (fractionated
to tolerance)
PDL 595 nm 7–8.5 J/cm2 1.5 ms 10 mm Fitzpatrick skin type IV and V,
with dynamic cooling, 2–3
sessions, once a month4
Nd:YAG 1064 nm 100 J/cm2 10–10 ms 3 mm For hypertrophic PWS
Venous malformation (3) Nd:YAG 1064 nm 80–160 J/cm2 3–6 mm Epidermal cooling, every 8–12 weeks
BRBNS (1) Nd:YAG 1064 nm 250 J/cm2 50 ms 4 mm Epidermal cooling, 4-week intervals2
glomuvenous Nd:YAG 1064 nm 50–240 J/cm2 30 ms 3–12 mm Epidermal cooling, every 2–6 months
malformation (7) PDL/Nd:YAG 595/1064 nm 6–9/50–110 J/cm2 0.5/20 ms 10/10 mm Every 6–12 weeks
Lymphatic malformation (3) PDL 595 nm 7–10 J/cm2 1.5 ms 7 mm Five sessions, every 2–4 months
Fractional CO2 10,600 nm 12 W 1.5 ms 7 mm One session after PDL

BRBNS: Blue Rubber Bleb Nevus Syndrome, PWS: Port Wine Stain
1
The same treatment spacing has been used for Nd:YAG surgery for IH
2
The number of treatments should be titrated to the clinical response and account for development of adverse treatment outcomes, non-responsive
lesions generally should not receive more treatments
3
See Fernandez-Vozmediano et al. (2010) for more customized settings
4
Stier et al. recommend waiting 3–6 months between treatments to allow post inflammatory hyperpigmentation to resolve

[23]. However, the use of Nd:YAG lasers for IH is generally
not recommended due to concerns regarding potential
hypopigmentation, scarring, ulceration, and lack of efficacy
[13, 24].
Ulcerated IH should be treated with pulsed dye laser (PDL)
1 to 2 weeks after failure of conventional therapy. Timolol or
propranolol are effective when used adjunctively [13, 17, 20].
Bleeding IH, which are frequently also ulcerated, can also be
treated with PDL [25]. PDL can both reduce pain and promote
rapid re-epithelialization in ulcerated IH refractory to medical
therapy; however, ulceration may worsen in patients with seg-
mental lesions [26, 27]. Additionally, well-developed IH that
are not completely involuting may be refractory to treatment
with PDL [28].
There are several relative contraindications to laser surgery
for IH. Children with numerous (> 3) IH should be evaluated
for visceral involvement, which may prompt treatment with
systemic modalities such as propranolol or corticosteroids.
Eyelid IH, as mentioned above, should be managed aggres-
sively with ophthalmological evaluation and possible steroids
or surgical debulking. Lasers are not indicated for eyelid IH
[3].
Telangiectasia
A PDL (595 nm) laser and a fractional KTP (532 nm) laser
have demonstrated efficacy in treating telangiectasias [29].
Typically, telangiectasia only requires one treatment with
PDL for complete resolution. This is consistent across various
forms of telangiectasia. When selecting the appropriate spot
size, it should correspond with the vessel diameter [20].
Furthermore, patients with hereditary hemorrhagic telangiec-
tasia may be managed with PDL (9.5 to 11 J/cm2, 1.5 ms, 5- to
7-mm spot size with dynamic cooling, wavelength not report-
ed) [30].

Pyogenic granulomas
PDL can be used for pyogenic granulomas that are small and
slightly raised [20, 31]. There has also been reported success
with treating hemorrhagic pyogenic granulomas using PDL
(585 nm, 6 to 14 J/cm2, 0.45 to 3 ms, 5- to 7-mm spot size,
with dynamic cooling) [25, 32]. Despite some success with
lasers for pyogenic granulomas, recurrence is common after
laser surgery [31]. Pyogenic granulomas have also shown to
be susceptible to Nd:YAG lasers. Fernandez-Vozmediano
et al. reported efficacy and safety after treating 10 patients.
Nd:YAG was used on PGs in different locations with effective
removal of the lesions after laser therapy. Various laser set-
tings were attempted [33].
Capillary malformations/port wine stains
In contrast to vascular tumors, which can involve both the
dermis and subcutis, port wine stains (PWS) are typically
confined to the papillary and superficial reticular dermis [24,
34]. While most PWS are initially macular, their surface may
become thickened and nodular during adulthood [24, 35, 36].
The approach to laser surgery on these superficial low-flow
vascular malformations is, therefore, unique. Currently, PDL
(585 to 595 nm, 4.8 to 8 J/cm2, 450 μs to 1.5 ms, 10-mm spot
size) is considered the gold standard treatment for PWS [18,
20, 24, 34, 37].
PWS in the pink macular phase tend to exhibit the best
treatment outcomes, which explains the superior treatment
response seen in younger patients [35, 36, 38]. The edges of
PWS tend to demonstrate more efficient clearance than central
regions after PDL, making smaller lesions with a high surface
area to total area ratio amenable to laser surgery [20].
Traditionally, PDL has been more effective for the treat-
ment of PWS in patients with lighter skin types. Concerns for
using PDL in darker skin types include the potential for light
absorption by epidermal melanin, which can result in a higher
risk of dyspigmentation as well as decrease the efficacy of the
laser by reducing its capability of penetrating vessels in the
dermis. However, Bae et al. reported two cases of patients
with Fitzpatrick skin type IV and V using PDL (595 nm, 7
to 8.25 J/cm2, 1.5 ms, 10-mm spot size, with dynamic cooling)
with favorable results [17, 39]. Increasing the wavelength al-
lows for less absorption of the laser energy by melanin, aiding
in not only increased penetration but also more selective
targeting of oxyhemoglobin [39]. In a reported 10-year fol-
low-up of a patient treated with PDL, the treatment results
improved even more than the results seen immediately after
treatment [37].
Although PDL is excellent for red predominant lesions,
purple PWS tend to be refractory to PDL surgery [34].
Purple lesions may be managed more effectively with
Nd:YAG [40]. Additionally, hypertrophic or nodular PWS
Lasers Med Sci
should be treated with Nd:YAG for better treatment depth
(1064 nm) [17]. Nd:YAG has also been reported to be more
effective in clearing hypertrophic PWS on the lips (064 nm,
100 J/cm2, 10 to 20 ms, 3-mm spot size, with cooling) [41].
When available, combined PDL/Nd:YAG (595/1064 nm) la-
sers are preferred for hypertrophic and nodular PWS due to
combined efficacy and penetration [17]. Residual scarring af-
ter Nd:YAG is a common complication, and Nd:YAG should
be avoided when possible [26].
Despite laser treatment options, such as argon and
Nd:YAG lasers, PDL is preferred because it often results in
near total clearance with minimal adverse effects [38].
Generally, lesions on the face are the most responsive to
PDL therapy, whereas those on the lower extremities tend to
respond poorly. Central forehead PWS have the most effica-
cious results, followed by the periorbital area, peripheral face
and neck areas, and lastly central facial area. Another impor-
tant factor to consider is the variability in vessel diameter
throughout the lesion that affects the laser parameters used
[18, 20, 38]. Despite having a good safety profile, pyogenic
granulomas and scarring have been reported in capillary
malformations treated with PDL and other lasers [26, 42].
PDL pulses should be spaced with a 10 to 20% target
overlap. When treating PWS, treatment endpoints include pur-
pura that develops instantly and a gray center in some cases.
Purpura typically persists for 7 to 14 days after treatment [19].
Development of a gray center indicates deeper laser penetra-
tion, which can lead to post treatment scarring. Areas with
central, gray clearing should not continue to be treated with
the PDL [18].
In general, treatment of PWS with PDL requires 8 to 10
treatments spaced 2 to 3 months apart [19]. Burns et al. rec-
ommend additional treatments with increasing fluence (0.5 to
1 J/cm2 increases) and pulse width (increased to 2 ms) [18].
Similar to cases of IH, post-regression telangiectasias can be
managed with 1 or 2 treatments of PDL [19].
Venous malformations
Patients seek treatment for venous malformations for a variety
of reasons; these include relief from pain and intravascular
clotting, as well as cosmetic reasons. Nd:YAG is currently
the laser of choice for the treatment of venous malformations,
especially thick or compressible lesions (1064 nm, 80 to
160 J/cm2, with diffuse, non-overlapping spot size and
cooling) [18, 40]. The wavelength of Nd:YAG specifically
targets blue vessels, increasing the effectiveness for treating
venous malformations [40]. The longer pulse widths utilized
also preferentially target thermocoagulation of larger vessels
which are not able to dissipate heat as readily as smaller ves-
sels [43]. Burns and Navarro utilized a 6-mm spot size for
deeper vessels and a 3-mm spot size for more superficial ves-
sels. The desired endpoints are immediate shrinkage/
Lasers Med Sci
disappearance or vessel thrombosis, both of which may be
rather striking; dermal nodularity should not be seen as an
endpoint as this is a risk for scarring [18].
Blue rubber bleb nevus syndrome
The success of Nd:YAG with venous malformations has also
been shown to extend to the rare blue rubber bleb nevus syn-
drome (BRBNS). Moser and Hamsch demonstrated regres-
sion of cutaneous BRBNS with one laser treatment for smaller
lesions and several treatments for larger ones (1064 nm, 250 J/
cm2, 50 ms, 4-mm spot size, with cooling) [43]. Most of the
lesions regressed substantially several weeks after treatment
with a follow-up period of 4 years.
Glomuvenous malformations
Due to their venous predominant nature, glomuvenous
malformations (GVM), including in PDL refractory lesions,
can be managed with Nd:YAG therapy (1064 nm, 50 to 240 J/
cm2, 30 ms, 3- to 12-mm spot size, with cooling) [44–46].
Similarly, Brauer et al. reported successful treatment of
GVMs using long-pulsed KTP laser (1064 nm) [47]. Trost
et al. attempted double pulsing on one area of GVM treated
with Nd:YAG. On follow-up, the test spot was the only focus
of scarring [48].
When treating GVMs with Nd:YAG, the immediate treat-
ment endpoint is moderate lightening and flattening of the
lesion [48]. Laser surgery for these lesions may benefit from
combined PDL/Nd:YAG therapy for combined superficial
and deep treatment with lower fluences needed than in mono-
therapy. Two cases of plaque type GVMs utilized this com-
bined laser therapy over 6 to 10 treatment sessions with no
complications (PDL, 595 nm, 0.5 ms, 6 to 9 J/cm2, 10-mm
spot size, and Nd:YAG, 1064 nm, 15 to 20 ms, 50 to 110 J/
cm2, 10-mm spot size and both with dynamic cooling) [49,
50].
Lymphatic malformations
A combined form of lymphatic and capillary malformations
known as lymphangioma circumscriptum (LC), or
microcystic lymphatic malformation, is susceptible to laser
therapy. A combination therapy of CO2/PDL/Er:YAG can
improve LC clearance [10]. These lasers only treat the super-
ficial portion of the lesion, and the deeper portions are not
affected by laser surgery. In a report by Akkaya et al., PDL
successfully treated the capillary component of a biopsy-
proven LC (595 nm, 7 to 10 J/cm2, 1.5 ms, 7-mm spot size)
at 2- to 4-month intervals. One session with fractional CO2
laser (10,600 nm, 12 W, 3.5 ms, 300-μm spot size) was per-
formed to target the lymphatic portion of the LC [51]. Lai et al.
utilized PDL (585 nm, 7.25 J/cm2, 450 μs, 7-mm spot size) for
a case of biopsy-proven LC after surgical excision [52].
Marked improvement was observed after 3 months. A second
treatment was performed 3 years later after several small ves-
icles reappeared, and the patient again responded well to laser
surgery. Lasers can also reduce the sequelae of lymphatic
malformations such as bleeding and lymphorrhea; however,
infected lesions should not be managed with lasers [10, 52].
Tufted angiomas
Tufted angiomas are notoriously difficult to treat.
Accordingly, the treatment of tufted angiomas presents physi-
cians with a unique clinical challenge, regardless of the treat-
ment modality chosen. While argon tunable dye and PDL
have been used on tufted angiomas, there has so far been little
success [23].
Conclusion
There may be a lack of awareness among dermatologists re-
garding laser surgery utility in the treatment of pediatric vas-
cular lesions. This review aims to guide clinical practice by
helping dermatologists understand the different laser options
available to them in the management of pediatric vascular
lesions. We explored the utility of laser surgery in the treat-
ment of IH, telangiectasia, pyogenic granulomas, PWS, ve-
nous malformations, BRBNS, glomuvenous malformations,
LC, and tufted angiomas. Moreover, we highlighted the spe-
cific laser types and settings that have contributed to the most
effective laser surgery outcomes in the treatment of each
unique type of vascular lesion.
Undoubtedly, vascular lesion treatment outcomes are
optimized when dermatologists employ careful clinical
judgment, good technical expertise, and possess an ade-
quate foundation of knowledge regarding laser indications
and limitations in each particular setting. High-quality,
randomized studies on laser surgery for pediatric vascular
lesions are scant, including the highly characterized laser
surgery for IH and PWS. Vascular lesions such as arterio-
venous malformations, combined complex vascular anom-
alies, kaposiform hemangioendotheliomas, and other rare
vascular tumors are lacking reliable studies altogether.
Large, randomized studies are needed to identify which
vascular lesions are truly amenable to laser surgery with
much needed clarification of the ideal device parameters.
Retrospective and observational studies are particularly
challenging for certain lesions, such as IH, which display
an unpredictable clinical course. Further scientific ad-
vances in laser surgery will continue to emphasize the val-
ue of this therapeutic option in the treatment of pediatric
vascular lesions.

Compliance with ethical standards
Conflict of interest Not applicable.
References
1. Buckmiller LM, Munson PD, Dyamenahalli U, Dai Y, Richter GT
(2010) Propranolol for infantile hemangiomas: early experience at a
tertiary vascular anomalies center. Laryngoscope. 120(4):676–681
2. Bruscino N, Bonan P, Cannarozzo G, Moretti S, Lotti T, Campolmi
P (2012) Laser use in infantile hemangiomas, when and how.
Dermatol Ther 25(4):314–321
3. Slaughter KA, Chen T, Williams E 3rd. (2016) Vascular Lesions.
Facial Plast Surg Clin North Am 24(4):559–571
4. Krowchuk DP, Frieden IJ, Mancini AJ, Darrow DH, Blei F, Greene
AK, Annam A, Baker CN, Frommelt PC, Hodak A (2019) Clinical
practice guideline for the management of infantile hemangiomas.
Pediatrics. 143(1):e20183475
5. Eivazi B, Werner JA. Extracranial vascular malformations (heman-
giomas and vascular malformations) in children and adolescents -
diagnosis, clinic, and therapy. GMS Curr Top Otorhinolaryngol
Head Neck Surg. 2014;13Doc02
6. Weber F, Chaudry G, Mulliken J, Voss S. Clinical presentation,
imaging characteristics and management of parotid hemangiomas.
Pediatr Radiol. 2013;43S442
7. Atas E, Kesik V, Koc O, Atas H. Clinical features and treatment
results of patients with hemangioma. Pediatric Blood and Cancer.
s;62S353
8. Blatt J, McLean TW, Castellino SM, Burkhart CN (2013) A review
of contemporary options for medical management of hemangi-
omas, other vascular tumors, and vascular malformations.
Pharmacol Ther 139(3):327–333
9. Chinnadurai S, Sathe NA, Surawicz T (2016) Laser treatment of
infantile hemangioma: a systematic review. Lasers Surg Med 48(3):
221–233
10. Cole PD, Sonabend ML, Levy ML (2007) Laser treatment of pedi-
atric vascular lesions. Semin Plast Surg 21(3):159–166
11. Garza G, Fay A, Rubin PAD (2001) Treatment of pediatric vascular
lesions of the eyelid and orbit. Int Ophthalmol Clin 41(4):43–55
12. Menapace D, Mitkov M, Towbin R, Hogeling M (2016) The
changing face of complicated infantile hemangioma treatment.
Pediatr Radiol 46(11):1494–1506
13. Higuera S, Gordley K, Metry DW, Stal S (2006) Management of
hemangiomas and pediatric vascular malformations. J Craniofac
Surg 17(4):783–789
14. Dementieva N, Jones S (2016) The treatment of problematic hem-
angiomas in children with propranolol and 940nm diode laser. J
Pediatr Surg 51(5):863–868
15. Elluru RG (2013) Cutaneous vascular lesions. Facial Plast Surg
Clin North Am 21(1):111–126
16. Elluru RG, Azizkhan RG (2006) Cervicofacial vascular anomalies.
II Vascular malformations Semin Pediatr Surg 15(2):133–139
17. Cordisco MR (2009) An update on lasers in children. Curr Opin
Pediatr 21(4):499–504
18. Burns AJ, Navarro JA (2009) Role of laser therapy in pediatric
patients. Plast Reconstr Surg 124(1 Suppl):82e–92e
19. Barčot Z, Župančić B (2010) Pulsed dye laser treatment of vascular
lesions in childhood. Acta Dermatovenerol Croat 18(3):201–208
20. Morelli JG (1998) Use of lasers in pediatric dermatology. Dermatol
Clin 16(3):489–495
21. Adams DM, Lucky AW (2006) Cervicofacial vascular anomalies. I.
Hemangiomas and other benign vascular tumors. Semin Pediatr
Surg 15(2):124–132
Lasers Med Sci
22. Batta K, Goodyear HM, Moss C, Williams HC, Hiller L, Waters R
(2002) Randomised controlled study of early pulsed dye laser treat-
ment of uncomplicated childhood haemangiomas: results of a 1-
year analysis. Lancet 360(9332):521–527
23. Metry DW, Hebert AA (2000) Benign cutaneous vascular tumors
of infancy: when to worry, what to do. Arch Dermatol 136(7):905–
914
24. Azizkhan RG (2003) Laser surgery: new applications for pediatric
skin and airway lesions. Curr Opin Pediatr 15(3):243–247
25. Kishi Y, Kikuchi K, Hasegawa M, Ohgushi K, Igarashi A,
Hatanaka M, Fujino J, Ikeda H (2018) Dye laser treatment for
hemorrhagic vascular lesions. Laser Ther 27(1):61–64
26. Azizkhan RG (2013) Complex vascular anomalies. Pediatr Surg Int
29(10):1023–1038
27. Chen TS, Eichenfield LF, Friedlander SF (2013) Infantile heman-
giomas: an update on pathogenesis and therapy. Pediatrics. 131(1):
99–108
28. Nasseri E, Piram M, McCuaig CC, Kokta V, Dubois J, Powell J
(2014) Partially involuting congenital hemangiomas: a report of 8
cases and review of the literature. J Am Acad Dermatol 70(1):75–
79
29. Nam CH, Kim MH, Hong SP, Park BC (2019) Fractional 532-nm
KTP diode laser and 595-nm pulsed dye laser in treatment of facial
telangiectatic erythema. J Cosmet Dermatol 18(3):783–787
30. Halachmi S, Israeli H, Ben-Amitai D, Lapidoth M (2014)
Treatment of the skin manifestations of hereditary hemorrhagic
telangiectasia with pulsed dye laser. Lasers Med Sci 29(1):321–324
31. Adams DM, Hammill A (2014) Other vascular tumors. Semin
Pediatr Surg 23(4):173–177
32. Tay YK, Weston WL, Morelli JG (1997) Treatment of pyogenic
granuloma in children with the flashlamp-pumped pulsed dye laser.
Pediatrics. 99(3):368–370
33. Fernandez-Vozmediano JM, Carranza-Romero C, Armario-Hita JC
(2010) Treatment of telangiectaticum granuloma with Nd:YAG
laser. J Am Acad Dermatol 62(3):AB148
34. Zhang B, Zhang TH, Huang Z, Li Q, Yuan KH, Hu ZQ (2014)
Comparison of pulsed dye laser (PDL) and photodynamic therapy
(PDT) for treatment of facial port-wine stain (PWS) birthmarks in
pediatric patients. Photodiagn Photodyn Ther 11(4):491–497
35. Tan OT, Gilchrest BA (1988) Laser therapy for selected cutaneous
vascular lesions in the pediatric population: a review. Pediatrics.
82(4):652–662
36. Powell J (1999) Update on hemangiomas and vascular
malformations. Curr Opin Pediatr 11(5):457–463
37. Crivaro P, Piva MMM, Ferrario D, Valeria AM, Kowalczuck A
(2017) Pulsed dye laser treatment of vascular malformation, 10
years follow up. Int J Dermatol 56(11):1290
38. Garden JM, Bakus AD (1993) Clinical efficacy of the pulsed dye
laser in the treatment of vascular lesions. J Dermatol Surg Oncol
19(4):321–326
39. Bae YS, Ng E, Geronemus RG (2016) Successful treatment of two
pediatric port wine stains in darker skin types using 595 nm laser.
Lasers Surg Med 48(4):339–342
40. Glade RS, Richter GT, James CA, Suen JY, Buckmiller LM (2010)
Diagnosis and management of pediatric cervicofacial venous
malformations: retrospective review from a vascular anomalies cen-
ter. Laryngoscope. 120(2):229–235
41. Kono T, Frederick Groff W, Chan HH, Sakurai H, Yamaki T
(2009) Long-pulsed neodymium:yttrium-aluminum-garnet laser
treatment for hypertrophic port-wine stains on the lips. J Cosmet
Laser Ther 11(1):11–13
42. Baselga E, Wassef M, Lopez S, Hoffman W, Cordisco M, Frieden
IJ (2012) Agminated, eruptive pyogenic granuloma-like lesions de-
veloping over congenital vascular stains. Pediatr Dermatol 29(2):
186–190
Lasers Med Sci
43. Moser CM, Hamsch C (2012) Successful treatment of cutaneous
venous malformations in a patient with blue rubber bleb naevus
syndrome by Nd:YAG laser. Br J Dermatol 166(5):1143–1145
44. Murthy AS, Dawson A, Gupta D, Spring S, Cordoro KM (2017)
Utility and tolerability of the long-pulsed 1064-nm neodymium:
yttrium-aluminum-garnet (LP Nd:YAG) laser for treatment of
symptomatic or disfiguring vascular malformations in children
and adolescents. J Am Acad Dermatol 77(3):473–479
45. Rivers JK, Rivers CA, Li MK, Martinka M (2016) Laser therapy for
an acquired glomuvenous malformation (glomus tumour): a non-
surgical approach. J Cutan Med Surg 20(1):80–83
46. Phillips CB, Guerrero C, Theos A. Nd:YAG laser offers promising
treatment option for familial glomuvenous malformation. Dermatol
Online J. 2015;21(4)
47. Brauer JA, Anolik R, Tzu J, Meehan S, Lieber CD, Geronemus RG
(2011) Glomuvenous malformations (familial generalized multiple
glomangiomas). Dermatol Online J 17(10):9
48. Trost J, Buckley C, Smidt AC (2015) Long-pulsed neodymium-
doped yttrium aluminum garnet laser for glomuvenous
malformations in adolescents. Pediatr Dermatol 32(5):e217–e218
49. Vargas-Navia N, Baselga E, Munoz-Garza FZ, Puig L (2017)
Congenital plaque-type glomuvenous malformation: 11 years of
follow-up and response to treatment with the combined pulsed-
dye and neodymium:yttrium-aluminum-garnet laser. Actas
Dermosifiliogr 108(1):72–74
50. Nguyen TV, Becker EM, Miller WA, Browning JC (2014) Plaque-
type glomuvenous malformations successfully treated using com-
bined pulsed dye laser and neodymium-doped yttrium aluminum
garnet laser. Dermatol Surg 40(1):89–92
51. Akkaya AD, Oram Y, Demirkesen C (2012) Combined lymphatic
and capillary malformation successfully treated with pulsed-dye
laser and fractional co2 laser. Eur J Pediatr Dermatol 22(1):39–40
52. Lai C-H, Hanson SG, Mallory SB (2001) Lymphangioma
circumscriptum treated with pulsed dye laser. Pediatr Dermatol
18(6):509–510
Publisher’s note Springer Nature remains neutral with regard to jurisdic-
tional claims in published maps and institutional affiliations.