Vascular growing lesions

Patient description

A 34-year-old female patient has presented since 2014 with progressively enlarging vascular papules and nodules on the left hemifacial region, which bleed easily upon minimal trauma.

The lesions are located on the buccal and nasal mucosa, as well as on the external surfaces of the cheeks and lips.

According to the patient, the lesions first appeared during pregnancy, with gradual worsening over time.

An angio-MRI was reported as normal, and a biopsy of a buccal lesion was consistent with a hemangioma.

Currently, the patient presents with ulcerated lesions emitting a fetid odor, for which she has been started on antibiotic therapy (metronidazole and amoxicillin–clavulanic acid).

She has previously undergone surgical excision and several sessions of electrocoagulation, but with recurrence of the lesions.

Her recent laboratory results show anemia (hemoglobin: 9 g/dL), most likely secondary to chronic bleeding from the vascular lesions.

Case description

Clinical questions:

Would it be appropriate to perform a facial angio-CT scan to identify a possible feeding vessel?

What would be the recommended management and therapeutic approach in this case?

I have access to a Fotona Nd:YAG laser (R33 handpiece, with 9 mm, 4 mm, and 2 mm spot sizes) — could this modality be used effectively for such vascular lesions?

Should this laser treatment be performed in a hospital/clinical setting because of the potential bleeding risk, or would it be safe to perform in a private practice?