Efficacy of intralesional bleomycin as an alternative approach in the management of vascular anomalies

Abstract

Aim: Cystic hygroma and hemangiomas are vascular anomalies which are mostly congenital in origin. The complications are increase in size of the swelling, infection, hemorrhage, dysphagia, respiratory distress, disfigurement, and recurrences. This study was done to assess the results of intralesional bleomycin. Materials and Methods: A retrospective analysis of patient demographics, clinical response, treatment, and complications were recorded in vascular anomalies from 2009 to 2016. Nine children (53%) with hemangiomas and eight children (47%) with cystic hygroma were included in the study. The bleomycin injection was given as 1 mg/kg/dose intralesionally in all except for face lesions where it was given as 0.5 mg/kg/dose and was repeated after 4 weeks in case of nonresolving lesions. Two to six bleomycin injections were required in 14 cases and remaining three resolved after single injection. The lesions were assessed on first follow-up for resolution at 4–6 weeks. Results: Out of the 17 children, 8 (47%) were male, and 9 (53%) were female. Sixteen children (94%) had lesions in the head, neck, and chest region and one had (6%) lesion on the hand. The lesions had completely resolved over 1–years in 14 (6 - hemangiomas and 8 - cystic hygroma) patients (82%) after bleomycin sclerotherapy, and one patient (hemangiomas) had 80% resolution and is on follow-up. Two patients (11%) had recurrence after six injections of bleomycin in chest cystic hygroma (1) and lip hemangiomas (1), and underwent surgical excision subsequently. Conclusion: The bleomycin injection sclerotherapy is effective, safe, and economical.