Birthmarks: Diagnosis and Therapy

Abstract

A diversity of complex and often confusing classifications of head and neck vascular lesions may be found in the literature. The majority of these are descriptive, based on clinical appearances and pathological (histologic) features, and are not useful in modern clinical practice. Pretherapeutic pathologic examination is difficult or even hazardous to obtain; significant haemorrhagic complications have been known to occur following biopsies of these lesions. The specimen obtained may not reflect the various components of the lesion, and does not take into consideration the type of flow present. The most useful classification would be one that could predict the clinical behavior of individual lesions, and lead to the selection of the most appropriate, currently available mode of therapy. At present the best available clinico-pathologic classification is that of Mulliken and Glowacki (1982), which includes tissue culture, histochemical and electron microscopic studies. It enlightens some of the most difficult aspects of these lesions and is based on the separation of vascular lesions into two groups: those with a proliferative and sometimes potentially involutive behavior (haemangiomas); and those without (vascular malformations) which can be further classified according to the morphology of the abnormal channels present. From our clinical and angiographic experience we have reached a similar type of classification.