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.
