Hope to Children with Congenital Birthmarks
Melody's first treatment with the Candela Pulsed-dye Laser was 13 little spots. That was all that Mom could take at first.
Rainbow Babies & Children's Hospital of Cleveland MacDonald Hospital for Women 2074 Abington Road Leonard C Hanna House Cleveland, Ohio 44106 Howard M. Hanna Pavilion 21~844-3177 George M. Humphrey Building, Robert H. Bishop Building Abington House affiliated with Wearn Medical Research Laboratories Case Western Harry J. BoweII Heath Center Reserve University University Hospitals Health Center/East School of Medicine University Suburban Health Center Department of Dermatology
September 19, 1989
John Hancock Preferred Emerald Health P 0 Box 308014 Cleveland, Ohio 44130
RE: Melody Brown,
To Whom It May Concern:
Iam seeing Melody Brown for a congenital port wine stain involving the right half of her body. She also has hemi hypertrophy of the involved limbs consistent with the diagnosis of Klippel-Trenaunay-Weber syndrome. The natural history of this disease is deepening of the color, increased edema of the effected extremities as well as increase in size, the possibility of developing nodules that may ulcerate and bleed, as well as the development of secondary infection. Therefore, the flash-lamp pulsed dye laser was selected as the treatment' of choice. This is an essentially painless and non-scarring procedure that is a truly preventive therapeutic option. It is not a cosmetic one. I have enclosed further information regarding the flash-lamp pulsed dye laser and should you have any questions, please do not hesitate to call.
Sincerely,
Teri A. Kahn, M.D. Director Pediatric Dermatology (216) 844-7160
TAK: dnw Encl.
The following attachment was also included with Dr. Kahn's letter:
The flashlamp-pumped pulsed-dye laser was developed for the treatment of hemangiomas, port-wine stains and other vascular lesions. In most cases this modality will replace the argon, carbon dioxide, and the neodymium: YAG laser as the treatment of choice.
This pulsed-dye laser was specifically developed to selectively damage the blood vessels in these lesions while minimizing damage to surrounding structures. This is accomplished by combining the appropriate laser parameters of wavelength, pulse duration and laser energy. Experimental studies have shown that selective damage to blood vessels can be achieved at a wavelength of 577 nm. This is accomplished by using a special rhodamine dye, which emits the desired wavelength. The target for this light energy is the blood chromophore oxyhemoglobin, which has a minor absorption band at 577 nm. The light energy is normally delivered at relatively high doses of 4.0 - 10.0 J/cm2 during therapy. The pulse duration, the length of time the laser emits its energy, is very short (300-400. u s) . It has been repeatedly shown that this complement of laser parameters limits the thermal damage to the blood vessels with relative sparing of the perivascular area.
Clinically, there are a number of advantages of the pulsed-dye laser in the treatment of these vascular lesions. There is an extraordinarily low incidence of pigmentary change and less than 1% incidence of scarring. There is also an absence of epidermal sloughing which eliminates the need for post operative wound care. No anesthetic is required by 80% of those treated, and a topical anesthetic is sufficient for the remainder. Most importantly, the pulsed-dye laser has opened up the treatment of port-wine stains and other vascular lesions to children, and has enabled treatment of those lesions that are located below the head and neck.
Not only will successful treatment of these vascular lesions spare the patient (often children) the significant psychological trauma associated with such a disfigurement, but it will also prevent progression of the disease process. These vascular lesions may increase in size over time with development of nodules, ulceration and bleeding. Depending on the location of the port-wine stain, the lesions may increase in size, sometimes with unilateral edema and distortion of the involved limb (Klippel-Trenaunay-Weber Syndrome). The treatment of these lesions with the flash-lamp pulsed-dye laser is truly a medical indication for preventive progression of disease.
During the treatment period strict protocols are adhered to, including informed consent and pretreatment skin testing to determine individual sensitivity to the laser. Pre-operative and post-operative photographic documentation is maintained, and the routine follow-up observation is required.
Attached is a selected list of references pertaining to the flashlamp pulsed-dye laser. If there are additional questions, please do not hesitate to contact me.
William S. Lynch, M.D. Director Dermatologic and Laser Surgery
The second surgery was a little less tense for Mom, so a larger patch was done.
You can see the results of the second surgery in this photo taken in 3 months after the second surgery. Also you will see the third surgery, the day after.
At age 3, Melody started to have Laser treatments done under a general anesthesia at Akron Children's Hospital.The surgery was and still is being performed by Dr. Michael J. Parker of Plastic and Reconstructive Surgery of Akron, Ohio
Here's Melody at age 6! You can see quite a difference since birth!
As Melody has gone through a growth spurt at age 10, her birthmark has become a little darker than at age 6. We are now in the process of trying the Sclero-Pulse Laser, which works at a different wavelength than the Candela or the Cynosure Laser. Results will be presented when they become available.
1. Anderson RR, Parrish JA: Selective photohemolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983; 220:524-527.
2. Morelli JG, Tan OT, Garden JM, et al: Tunable dye laser (577nm) treatment of port-wine stains. Laser Surg Med 1986; 6; 6:94-99.
3. Garden JM, Tan OT, Kerschmann R, et al: Effect of dye laser pulse duration of selective cutaneous vascular injury. J Invest Dermatol 1986; 87:653-657.
4. Jan OT, Carney JM, Marcolis R, et al: Histologic responses of port-wine stains treated by argon, carbon dioxide, and tunable dye lasers: a preliminary report. Arch Dermatol 1986; 122:1016-1022.
5. Garden JM, Tan OT, Parrish JA: The pulsed dye laser: its use at 577nm wavelength. J Dermatol Surg Oncol 1987; 13; 2:134-138.
6. Garden JM, Polla LL, Tan OT: The treatment of port-wine stains by the pulsed dye laser. Arch Dermatol 1988; 124:889-896.
