Successful Treatment of Congenital Lymphangioma Circumscriptum of the Vulva with CO2 and Long-Pulsed Nd:YAG Lasers
A 16-year-old Japanese girl presented with a 9-year history of vesicles on both sides of the vulva (fig. ). These lesions had developed at around 7 years of age and no treatment had been administered. The patient sought treatment at our hospital because of increased lymphatic leakage. Clinical examination revealed grouped vesicular lesions on the vulva, giving it a typical ‘frog spawn’ appearance. The medical history of the patient showed no other dermatologic or systemic abnormalities, and no family history of similar lesions was evident. A biopsy was taken from the middle of the affected area. Histopathologic examination revealed multiple thin-walled, dilated lymphatic spaces that contained lymphocytes and erythrocytes in the papillary dermis (fig. ). Clinical and pathologic findings were consistent with a diagnosis of LC.\nWe decided to use different kinds of lasers for the right and left lesions. Once a month, we treated the right-side vulval lesion with a CO2 laser (SHARPLAN 30C, Lumenis, Yokneam, Israel) and the left-side lesion with a long-pulsed Nd:YAG laser from the XeoTM multi-platform device (Cutera, Brisbane, Calif., USA) under local anesthesia with 1% lidocaine plus 1:100,000 epinephrine. The CO2 laser was set to a wavelength of 10,600 nm at 4 W with a 1-mm spot size. Visually confirming cauterization of lymphatic channels on the surface, we treated the lesions little by little every month, as treatment of a wide area in a single session may lead to ulceration. The long-pulsed Nd:YAG laser was set to a wavelength of 1064 nm with a fluence of 80–100 J/cm2 at 20 or 30 ms and a 7-mm spot size. Energy and pulse length were adjusted to achieve only partial coagulation.\nAfter the fourth session, the region on the right vulva treated with the CO2 laser was greatly improved, with no lesions visible to the naked eye. The region on the left vulva was greatly improved after only 3 treatments using the Nd:YAG laser. The patient preferred the results from the Nd:YAG laser as lymphatic fluid discharge was temporarily increased (for 1 week) after each CO2 laser irradiation, but stopped after Nd:YAG laser irradiation. However, the second session of irradiation with the Nd:YAG laser resulted in the development of a 4-mm linear scar after 1 week, which appeared as a slight textural change that disappeared within 3 months.\nAfter completion of the laser treatment (4 sessions), the patient no longer needed to use incontinence diapers and her quality of life improved considerably. No recurrence has been detected yet, 2 years after the last treatment, although follow-up is continuing (fig. ).