The treatment of microcystic and combined
lymphangiomas, especially in the head and neck region, is still a challenge because the
lymphangiomas do not respond to conventional
therapies and their recurrence rate is high, regardless of the treatment choice. Complete surgical resection is the main treatment of
lymphangiomas, but because of localization perioperative complications, such as
bleeding, neural damage and
airway obstruction are common disadvantages of this method.
Bleomycin-based
sclerotherapy is another common therapeutic approach, in which the lymphocysts are aspirated, and 25% to 50% of their volumes are replaced with a sclerotisant
drug. This is an effective treatment in cases in which the vessels are large enough for an intravascular or intracystic injection, but because of the small size of vessels and
cysts, the microcystic and combined
lymphangiomas are not suitable for
sclerotherapy. Delivery of drugs for treating
sclerosis to endothelial cells can be achieved by electroporation (electrochemotherapy), even for capillary malformations. A congenital, rapidly growing combined
lymphangioma of the left cervicofacial region was treated with one session of
bleomycin-based electrochemotherapy. Seven months
after treatment, the growth-corrected target volume decrease was 63% and the dislocation of the trachea and blood vessels previously observed had ceased. We suggest that
bleomycin-based electrochemotherapy is a feasible alternative treatment option for capillary malformations.