Treatment of Nevi with Radium

Abstract

OF nevi, or birthmarks, those anomalous developments of certain tissues of the skin and subcutaneous structures, there are two main varieties to be considered in connection with radium treatment—the pigmented and the vascular. The pigmented are characterized not only by increased deposit of pigment, but at times by hypertrophy of other cutaneous structures. Vascular nevi, of course, are those characterized by an overgrowth of vascular tissue. Both types of lesions—as is well known—are congenital, and appear at birth or shortly thereafter. A large percentage of them develop on the face and neck, so that the treatment becomes not simply a question of removing an objectionable overgrowth of tissue, but one of very careful treatment to obtain the best cosmetic effect. There is a large classification of pigmented nevi, and the treatment depends upon a number of factors, such as position, size—both as to elevation and surface involvement—presence or absence of hair, fatty consistency, or very deep pigmentation with a tendency toward malignant changes. Small, faintly pigmented nevi are probably best removed by desiccation. When the surface involvement is great, radium must be considered, or at least radium combined with desiccation, because there is less scarring following judicious radium treatment. Hairs must be removed by the electric needle previous to removing the nevus by some other method, but if radium is used, beta radiation will cause epilation. All deeply pigmented moles showing a tendency towards overgrowth or inflammatory irritation should have sufficient dosage of beta radiation to destroy absolutely the tissue involved. This will prevent the malignant development of the pigmented mole. If I may be permitted to repeat a familiar classification, there are three types of vascular nevi: 1. Nevus flammeus, or port wine mark. This is flat, non-elevated, and consists of a network of dilated capillaries. 2. Nevus vasculosus, or elevated angioma, consisting of a network of large dilated blood vessels. 3. Angioma cavernosum, consisting of enormously dilated blood vessels, which destroy the surrounding tissues by mechanical interference. There are, besides, a number of elaborate classifications, but this one by McKee, from the standpoint of treatment, is concise and covers the subject. Port wine marks vary greatly in size, from very small lesions to extensive ones involving an entire limb, the chest, or half or more of the face. They are usually of a brilliant red or purplish red hue, this, of course, varying according to the vascularity of the mark. The edge is usually irregular. There is no question but that port wine marks are the most difficult to treat with satisfactory results. To produce an even fading of the color is almost an impossibility.