Videomicroscopy of venular malformations (port-wine stain type): prediction of response to pulsed dye laser.

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.