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Vascular and pigmented lesions include a variety of skin discolorations, some of which are present at birth and some that are acquired after birth. Vascular lesions appear as red marks on the skin; the red is due to a concentration of blood that can be seen through the outer layers of skin. Pigmented lesions are brown if they are due to the body's natural pigment or can be a great variety of colors if they are due to pigments that have been introduced into the body.

Who may be affected?

Vascular and pigmented lesions appear about equally in patients of all races and both genders. They are not passed genetically from one generation to the next.

What forms do they take?

Vascular lesions most frequently appear on the face, neck, and upper body, and include port wine stains and strawberry hemangiomas. Port wine stains are present at birth and grow larger as the patient grows, thereby covering the same relative proportion of skin. As the patient gets older, port wine stains can turn darker red and become more prominent. With time, they can also grow thicker and less smooth. Strawberry hemangiomas develop after birth, grow rapidly, and usually go away on their own. Unless the lesion bleeds or interferes with a vital function, no treatment is necessary. Pigmented lesions include those that are due to the body's natural pigment, such as cafe au lait spots, moles, freckles, and liver spots, as well as tattoos, which are caused by the introduction of foreign pigments into the skin. Cafe au lait spots are tan lesions of irregular shape that are present at birth. Moles, which are also present at birth, are smaller and more regular in shape. Freckles and liver spots appear after birth in response to sunlight exposure and age. All these types of lesions are due to the overproduction of pigment by pigment cells, or by too high a concentration of pigment cells. Tattoos are produced by introducing pigmented particles into the skin, usually by piercing the skin with a needle coated with the pigment. The needle passes through the outermost layer of skin and deposits the pigment into a lower layer of skin or fat. Tattoos done by amateurs produce tattoos of a single, blue-black color. Professional tattoos usually have a higher density of pigment and can include a variety of colors.

What causes them?

Vascular lesions are caused by the unregulated growth of blood vessels in an area that follows no discernible pattern of distribution. The vessels are larger than normal and can be thought of as loose, baggy vessels filled with blood. The reason for this unregulated blood vessel growth is not known. Pigmented lesions, aside from tattoos, result from a similar lack of regulation in the production of pigment or pigment cells. The reason for this is also unknown, although pigment cells can migrate from surrounding areas to concentrate in one place. Tattooing of skin causes the body to send special cells to the area to clean up the foreign material. These cells envelop the pigment particles. Some of the cells carry the pigment away for disposal, but some of the cells remain and hold the pigment that can be seen through the outer layers of skin.

What can be done?
Vascular lesions can usually be evaluated with only a visual examination. Pigmented lesions are sometimes biopsied to make sure they are not cancerous. The physical nature and distribution of a lesion tell the doctor most of what he or she needs to know about how to proceed with treatment. Many vascular and pigmented lesions respond well to laser treatment.

For vascular lesions like port wine stains, a yellow-green laser is used. It is held just over the skin, and pulses of laser light are directed systematically over the affected area. Energy from the laser passes through the skin and is absorbed by red blood cells within the blood vessels that make up the lesion. The red blood cells heat up, melt, and seal the blood vessel. The procedure is not painful; most people report that each pulse feels like a little mosquito bite.

Once the blood vessel is sealed off from blood circulation, the body slowly breaks it down and reabsorbs it. The loss of these blood vessels is not harmful, as most blood vessels in the skin function to allow the body to send blood to the surface for cooling; most are not essential for supplying skin tissue with oxygen. When necessary, the body will often make new blood vessels to replace the ones destroyed by the laser.

This same procedure can be used to treat people whose skin is marked with a pattern of broken blood vessels. This web of thin, red lines can be present at birth, or can develop as a result of sun exposure or certain diseases. Pigmented lesions that respond well to laser treatment include cafe au lait marks, freckles, liver spots, and tattoos. Moles are not good candidates for laser treatment because of the theoretical possibility that it can irritate them into becoming skin cancer.

A ruby (red) laser is used to treat the area with a series of pulses similar to the way vascular lesions are treated. The laser energy passes through the skin and is absorbed by the pigment molecule, which heats up and bursts. Professional tattoos, with their variety of colors are more difficult to remove than amateur tattoos. This is because the exact characteristics of laser energy best absorbed by blue-black amateur tattoos is well known, whereas the energy best absorbed by each possible variation of color tattoo is not as easily anticipated. Because more energy is used in treating pigmented lesions than vascular lesions, it is slightly more painful. Most people report that it feels like a rubber band snapping against the skin.

If necessary, an anesthetic cream can be applied before treatment to reduce the discomfort. Following laser treatment for vascular or pigmented lesions, a scab may form and the area will be black and blue for one to two weeks. After about two months, the treatment may be repeated, sometimes more than once, to treat the next layer of vessels or pigment under the layer already treated. Depending on the lesion's thickness, final results are likely to be a much less prominent mark and often, but not always, a complete removal of the mark.

What can I do?

The most important thing for you to do is to protect the lesion from the sun both before and after treatment. Sun exposure encourages pigment production, and pigment absorbs light and interferes with laser treatment. Have your lesion evaluated by a dermatologist. Not all lesions respond well to laser treatment or offer good cosmetic results. Dr. Levy has the experience to know when laser treatment can best be used.

Epidermal Pigmented Lesion Removal

The Medlite 532 nm (green) wavelength has a significant application in the removal of epidermal pigmented lesions. Research has shown excellent clearing with no incidence of hypopigmentation.

Dermal Pigmented Lesion Removal

The infrared wavelength of the Medlite is extremely successful in the treatment of dermal melanocytosis, such as nevus of Ota and aberrant Mongolian spots. Extensive early research was conducted by physicians in Japan and Korea, with thousands of patients treated to date. Multiple treatments were spaced at 2 month intervals or greater. No permanent side effects were observed. Only occasional transient hyperpigmentation was noted, usually resolving within two months. In all cases lesions lightened after each treatment and significant lightening occurring after multiple treatments.

Vascular Lesion Removal

The green wavelength is clinically successful in the removal of numerous vascular lesions. Protocol trials demonstrated Medlite's output was most successful in treating telangiectasia, angiomas, spider nevi, small port wine stains and Campbell de Morgan spots. Often times, more than one treatment is necessary. Interestingly, some lesions, successfully treated by the Medlite, had in fact failed treatment by other lasers. Purpura, which typically clears within one week, will be evident immediately following treatment.