Angiokeratoma Circumscriptum Treatment & Management

Updated: Sep 08, 2016
  • Author: William P Baugh, MD; Chief Editor: William D James, MD  more...
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Treatment

Medical Care

Medical care of these superficial vascular lesions is not usually required unless trauma occurs to the lesions.

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Surgical Care

Angiokeratoma circumscriptum lesions are asymptomatic benign vascular malformations that require no treatment. Nevertheless, surgical treatment is often rendered for cosmesis or because of clinical concern regarding the possibility of melanoma. Either ablation (after a firm diagnosis is established) or excision of the lesions (when the diagnosis is uncertain) can be performed. Depending on the size and the location of the angiokeratoma, simple excision may be the treatment of choice. Small lesions may also be treated with diathermy, curettage, and cautery.

Laser ablation

Laser ablation has proven highly effective and may offer the best cosmetic outcome. Specifically, the argon laser has been reported to effectively eliminate angiokeratomas, although associated scarring and posttreatment hypopigmentation are risks. [21, 22]

One treatment approach is to initiate treatment with an erbium or carbon dioxide laser to remove the hyperkeratotic-acanthotic epidermis, followed by the use of a laser that targets hemoglobin, such as the flash pump dye, KTP, or 880-nm diode laser. [23, 24]

Alternatively, an erbium or carbon dioxide laser may be used alone, although this approach may cause significant collateral thermal damage to the dermis and, thus, significant scarring may ensue.

A KTP laser or 800-nm diode laser may also be used alone, although multiple procedures may be needed for adequate treatment, depending on the underlying vessel diameter and the overlying epidermal thickness. Because of its wavelength and deeper dermal penetration, the 800-nm diode laser may be most useful for blue-black angiokeratoma circumscriptum or those with thrombosed vessels.

The KTP laser destroys vascular targets and is relatively specific for cutaneous blood vessels; therefore, it is ideal for the treatment of cutaneous vascular lesions. It causes less purpura than other laser systems, and patients are able to return to work immediately after treatment to the face. A typical setting for a 532-nm KTP laser for trunk angiokeratomas might be a fluence of 16-20 J/cm2 with a pulse duration of 30-50 milliseconds and a spot size of 4 mm.

Other ablative therapies

Other superficial ablative therapies, such as cryotherapy, may also be effectively used to treat superficial angiokeratomas. Recurrence of the lesion after surgical excision or ablation should bring into question the original diagnosis, and histopathologic examination of the lesions should be incorporated into the evaluation of the process in such an event.

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Consultations

Consult a dermatologist for both diagnostic and therapeutic suggestions. Submit all biopsy specimens to a dermatopathologist.

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