Intralesional Bleomycin Injections as treatment of vascular malformations and haemangiomas.
Haemangiomas and Vascular malformations may present at any age from birth. The way they present may vary considerably from a minor cosmetic impairment to life threatening complications.
The group name vascular malformation includes many conditions e.g. haemangiomas, venous malformations, arterio-venous malformations, capillary malformations, lymphatic lesions and even some mixed malformations.
In most cases the only special investigation required is an MRI examination that defines the extent of disease and the anatomy of the region. In some superficial lesions a clinical examination is all that is required for an accurate diagnosis and treatment plan but this will vary from case to case.
Intralesional Bleomycin as treatment of these lesions has been developed in Japan and Europe and more literature is becoming available daily.
The majority of patients complain of pain, swelling, reduced ability to perform certain tasks, major cosmetic problems, psychological stress, or bleeding. Often they have received other treatments for this condition e.g. surgery, laser, steroids, embolization, etc with varying results but seldom complete resolution and sometimes complications of these treatments.
The treatment comprises percutaneous injection of Bleomycin into the lesion. As this is a painful procedure and as multiple punctures may be required per injection session, most cases are performed under general anaesthesia. This is usually performed as a day surgery procedure, very occasionally requiring overnight hospitalisation.
The dose injected depends on the size of the lesion, age and weight of the patient - never more than 15 mg per session, to no more than 200 mg/m2 body surface area in total. At this total dose, we have not attained half the dose that has been proven to give pulmonary complications (450 - 500 mg/m2). At average, five sessions are required at two to six weekly intervals.
As a rule, the treatment is very well tolerated by patients with a period of 24-48 hours of discomfort at the site of injection and also some swelling. If the lesion were to be in the head and neck, hands, feet, or perineum, this period of discomfort may require sick leave.
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