Reviews

Contemporary methods of treating venous lake lesions

on the oral mucosa: A literature review
Mateusz TrafalskiA–D, Kamil JurczyszynE,F
Department of Dental Surgery, Faculty of Dentistry, Wroclaw Medical University, Poland

A – research concept and design; B – collection and/or assembly of data; C – data analysis and interpretation;
D – writing the article; E – critical revision of the article; F – final approval of the article

Advances in Clinical and Experimental Medicine, ISSN 1899–5276 (print), ISSN 2451–2680 (online) Adv Clin Exp Med. 2025

Address for correspondence

Mateusz Trafalski
Abstract
E-mail: mateusz.trafalski@umw.edu.pl A venous lake (VL) is a vascular lesion arising from dilated venous vessels surrounded by thick fibrous tissue,
located in the upper layers of the dermis. It can also appear in the oral cavity, especially on the lips, buccal
Funding sources
None declared
mucosa and tongue. Recurrent bleeding or aesthetic complaints are the most common reasons for the treat-
ment of these lesions. This review aims to present the current state of knowledge regarding the treatment
Conflict of interest of VL lesions in the oral cavity. PRISMA guidelines were followed. Articles were searched in the following
None declared databases: Pubmed, Medline and Scopus. The authors of this study analyzed scientific works concerning
VL treatment. Keywords searched included “venous lake”, “venous lake treatment”, “sclerotherapy”, “laser”,
“laser photocoagulation”, “infrared coagulation”, and “diathermocoagulation”. Two articles described electro-
Received on April 3, 2024 coagulation, 10 articles focused on photocoagulation using laser devices, 2 articles studied photocoagulation
Reviewed on April 26, 2024
Accepted on May 8, 2024 with infrared, and 4 articles described sclerotherapy for the treatment of VL lesions. The most effective
therapeutic options were electrocoagulation, 808 nm diode laser photocoagulation and 1064 nm Nd:YAG.
Published online on September 25, 2024
Key words: electrocoagulation, oral mucosa, sclerotherapy, laser photocoagulation, venous lake

Cite as
Trafalski M, Jurczyszyn K. Contemporary methods of treating
venous lake lesions on the oral mucosa: A literature review
[published online as ahead of print on September 25, 2024].
Adv Clin Exp Med. 2025. doi:10.17219/acem/188464

DOI
10.17219/acem/188464

Copyright
Copyright by Author(s)
This is an article distributed under the terms of the
Creative Commons Attribution 3.0 Unported (CC BY 3.0)
(https://creativecommons.org/licenses/by/3.0/)
2 Trafalski, K. Jurczyszyn. Venous lake treatment methods

Introduction was conducted in October 2023. It included publications

from 1987–2023. Articles were searched in the following
A venous lake (VL) is a vascular lesion arising from di- databases: PubMed, Medline and Scopus. The authors
lated venous vessels surrounded by thick fibrous tissue, analyzed scientific works, especially in terms of innova-
located in the superficial layers of the dermis.1 It was first tive and minimally invasive approaches for the treatment
described in 1956 by Bean and Walsh.2 It occurs most of VL lesions. Key words searched included “venous lake”,
frequently in older people in areas of the body exposed “venous lake treatment”, “sclerotherapy”, “laser”, “laser
to direct sunlight, such as the ears, face, hands, and lips.3 photocoagulation”, “infrared coagulation”, and “diather-
Another location of these lesions is within the oral cavity mocoagulation”. The inclusion criteria were full text ar-
with involvement of the labia, buccal mucosa and tongue. ticles in English published in peer-reviewed journals de-
In the oral cavity, they manifest as well-defined, painless, scribing the treatment of VLs located exclusively within
navy blue or purple, usually single, convex lumps, ranging the oral cavity (case reports, case series and clinical trials).
from a few to a dozen millimeters in diameter, and have Letters to the editor, editorial comments and congress
a positive diascopic effect.4 The characteristic clinical ap- speeches were not analyzed in this study. Furthermore, ar-
pearance is sufficient to make a diagnosis; therefore, collect- ticles that focused on the treatment of VLs located outside
ing specimens for histopathological examination is usually the oral cavity were not included in the analysis. Empha-
not necessary. Research by Tobouti et al. reported that a VL sis was placed on papers presenting unique information,
is the 2nd most common vascular lesion in the oral cavity expanding the review to include rarely published articles
after pyogenic granuloma.5 Recurrent bleeding or aesthetic and innovative methods of treating VLs. Selected treat-
complaints are the most common reasons for the treatment ment methods were described, along with a discussion
of these lesions.6 An additional factor encouraging patients of the studies in which they were used.
to undergo therapy is the fear of cancer transformation.7
Current methods of treating these lesions include surgical Data selection
excision, cryosurgery using liquid nitrogen, electrocoagu-
lation, infrared photocoagulation, laser photocoagulation, A total of 68 potentially relevant papers were found.
and sclerotherapy.8–12 For the treatment of lesions located Fifty publications were excluded due to a lack of a full
in the oral cavity, laser photocoagulation, infrared pho- text or duplications in the databases; those that were not
tocoagulation, electrocoagulation, and sclerotherapy are relevant or included VL locations outside the oral cavity
most often used. However, there is still no consensus which were also ommitted. Ultimately, 18 articles were included
of these methods is the most effective. The gold standard in the analysis (for most of the articles, PubMed and Med-
is surgical excision, which has the lowest recurrence rate. line gave similar results – we found 12 articles in the men-
However, it is associated with a longer recovery and more tioned databases and 6 articles in Scopus). A workflow
pain and scarring. These lesions are often located in aes- diagram of article selection is shown in Fig. 1.
thetically sensitive areas, which is a driving factor for the use
of minimally invasive or selective treatment methods, free Data collection
from the complications associated with surgical excision.
Therefore, further research to standardize the treatment The collected data are presented in Table 1,4,10,11,13–27 ac-
of VL lesions in the oral cavity using minimally invasive cording to parameters such as authors, year of publication,
methods, considering the above facts, is justified. number of lesions covered by the study, treatment method,
There are few studies and articles in the scientific lit- healing period, results/conclusions, and post-treatment
erature concerning the treatment of VLs in the oral cav- complications. We found 2 articles describing electroco-
ity. Since this is a common clinical problem, especially agulation, 10 articles focusing on photocoagulation using
in patients over 50 years of age, knowledge of treatment laser devices, 2 articles presenting photocoagulation with
techniques is essential to improve this area of oral surgery. infrared lasers, and 4 articles describing sclerotherapy.

Objectives Results
This review aims to present the current state of knowl- Electrocoagulation
edge regarding the treatment of VLs in the oral cavity.
This method uses high-frequency electric current, caus-
ing a dramatic increase in the temperature of the tissues
Materials and methods exposed to it.28,29 It can be used to cut or burn soft tissue
structures. The indisputable advantage of this method
This review aims to discuss the current treatment meth- is the simultaneous coagulation of blood vessels that mini-
ods and the research conducted. The literature review mizes intraprocedural bleeding, which is highly desirable
Adv Clin Exp Med. 2025 3

in the case of VLs. The technical approach to VLs may be Poonia et al. performed electrocoagulation of a VL lo-
the excision of these lesions or their coagulation. However, cated on the lower lip using monopolar coagulation in 1 pa-
only the 2nd option is found in the literature for the treat- tient.11 A modification of this method consisted of intro-
ment of oral VLs. ducing a 20 G needle into the lesion, to which a monopolar

Table 1. Summary of venous lake treatment methods

Number Number Local Follow-up
Healing
Author/year of treated of treatment Treatment method anes- Results Adverse effects observa-
period
lesions sessions thesia tion
laser type Nd:Yag
λ 1,064 nm
mode contactless
modulation IMP swelling disap-
Migliari et al. full
16 1 2–4 weeks absent pearing after –
20154 power 2W recovery
1–2 days
energy
–
density
spot
–
diameter
photocoagulation with infrared full recovery
light (80%), par-
1 (85%)
Ah-Weng tial recovery post-procedural
20 2 (10%) number – applied 1–6 months
et al. 200410 2–4 pulses with scar bleeding (15%)
3 (5%) of pulses
formation
pulse length 1.0–1.5 s (20%)
Poonia et al. electrocoagulation inside full
1 1 no data applied absent 18 months
201911 the lesion recovery
Weiss et al. electrocoagulation inside full
8 1 no data applied absent 3 months
201413 the lesion recovery
laser type laser diode
λ 808 nm
slight swelling
mode contactless
resolved after
modulation CW 2 days, minimal
Azevedo et al. full
17 1 2–3 weeks applied post-procedure –
201014 power power: 2–3 W recovery
pain, 5.9% (1 pa-
energy tient required
20 J/cm2
density painkillers)
fiber
300 µm
diameter
laser type laser diode
λ 980 nm
mode contactless mode moderate
post-procedure
modulation CW
Voynov et al. full pain/2.8%
35 1 2–4 weeks applied –
201615 power power: 2–3 W recovery (1 patient)
post-procedure
energy 224 J/cm2
bleeding
density 334 J/cm2
fiber diam- optical fiber
eter diameter: 300 µm
laser type alexandrite laser
λ 755 nm
mode –
80.49% full
1 (90.24%) modulation IMP: 3 ms recovery,
Wang et al.
41 2 (7.32%) – – 19.51% scar – 1 case –
202116 power –
3 (2.44%) partial
energy recovery,
50–90 J/cm2
density
spot
8 mm
diameter
4 Trafalski, K. Jurczyszyn. Venous lake treatment methods

Table 1. Summary of venous lake treatment methods – cont.

Number Number Local Follow-up
Healing
Author/year of treated of treatment Treatment method anes- Results Adverse effects observa-
period
lesions sessions thesia tion
laser type PDL – air cooling
λ 595 nm
mode –
modulation IMP: 2–10 ms
power –
82.4% full
energy recovery,
7–11 J/cm2
density 17.6%
spot diam- partial
7 mm recovery,
eter
Yang at al. 1–2 (82.4%) including swelling lasting 3 months
17 Nd:YAG – air 4–16 weeks optional
201717 1–3 (17.6%) laser type (5.9%) no 2–3 days –6 years
cooling response
λ 1,064 nm to treat-
ment
mode – – relapse
modulation IMP: 15–40 ms after a year
power –
energy
35–40 J/cm2
density
spot
–
diameter
laser type PDL
λ 595 nm
mode –
modulation IMP: 20 ms
power –
energy
10 J/cm2
density
spot present
– full
Roncero et al. 1 (89.25%) diameter 12– in 1/3
39 recovery 5.12% scar –
200918 2 (10.75%) laser type Nd:Yag 14 weeks of pa-
(95%)
tients
λ 1,064 nm
mode –
modulation IMP: 20 ms
power –
energy
70 J/cm2
density
spot
–
diameter
laser type Nd:Yag
λ 1,064 nm
mode contactless
modulation IMP
Armogida full
50 1 4 weeks absent small scar (2%) 2 years
et al. 202319 power – recovery
energy
100 J/cm2
density
spot
2.5 mm
diameter
Adv Clin Exp Med. 2025 5

Table 1. Summary of venous lake treatment methods – cont.

Number Number Local Follow-up
Healing
Author/year of treated of treatment Treatment method anes- Results Adverse effects observa-
period
lesions sessions thesia tion
laser type PDL
λ 595 nm full
mode – recovery
1 (12.5%) (25%),
Chenung modulation –
2 (25%) partial
and Lanigian 8 – – absent –
3 (50%) power – recovery
200720
5 (12.5%) (12.5%, no
energy
8.5–13 J/cm2 response
density
(62.5%)
spot
7 mm
diameter
laser type argon laser
λ –
optional
mode –
(5.9% full
1 (76.4%)
Neumann modulation IMP: 300 ms of pa- recovery
2 (9.8%)
and Knobler 51 10–20 days tients (98.04%), scars 10% 18 months
3 (7.8%) power 1.8–3 W
199021 received recurrence
4 (5.8%) energy anesthe- (1.96%)
–
density sia)
spot
1.5–2.0 mm
diameter
laser type diode laser
λ 980 nm full recov-
mode contactless ery (83%),
scarring
IMP: 100 ms, 50%
modulation (9%), partial
Trafalski et al. 1 (83%) duty cycle
23 4–12 weeks applied recovery scars (9%) 3–6 months
202122 2 (17%)
power 6W (4%), no
response
energy
– to treat-
density
ment (4%)
spot
–
diameter
photocoagulation with infrared
light
full
Colver and slight recess
10 1 number 2–3 weeks applied recovery 4 months
Hunter 198723 1 (20%)
of pulses (100%)
pulse length 1.125 s
sclerotherapy
swelling, red-
Fernandez 1 (85%) chemical 5% ethanolamine full ness, burning
33 2–6 weeks applied 3–6 months
et al. 202024 2 (15%) compound oleate recovery sensation, last-
ing 1–3 days
volume 0.3–0.9 mL
sclerotherapy
full slight scar,
Kuo and Yang chemical
2 2 1% polidocanol 4 weeks applied recovery hyperpigmenta- 6 months
200325 compound
(100%) tion (50%)
volume 0.6–1.0 mL
sclerotherapy
chemical
1% polidocanol
compound angioedema
1 (32%)
(8%), slight
2 (28%) volume cal- full
Cebeci et al. scarring and dis-
25 3 (24%) culated based 8–16 weeks applied recovery 6 months
202126 coloration (8%),
4 (8%) on the diam- (100%)
pain during
5 (8%) volume eter of the lesion
the procedure
(0.3 mL/3 mm
diameter
of the lesion)
6 Trafalski, K. Jurczyszyn. Venous lake treatment methods

Table 1. Summary of venous lake treatment methods – cont.

Number Number Local Follow-up
Healing
Author/year of treated of treatment Treatment method anes- Results Adverse effects observa-
period
lesions sessions thesia tion
1 (38.46%) sclerotherapy
2 (30.77%) full pain and par-
Jung et al. chemical 10–49
12 3 (15.38%) 0.5% STS 2–12 weeks applied recovery esthesia during
200827 compound months
4 (7.69%) (100%) injection
5 (7.69%) volume 0.05–0.2 mL

“–“ – no data; CW – continuous wave; IMP – pulse mode; STS – sodium tetradecyl sulfate.

Fig.1. Workflow diagram

of the articles selection

tip with an energy of 4 J was applied. Thanks to this so- a 3-month observation period, full recovery of all lesions
lution, the energy was transferred directly to the inside was observed and no side effects were detected. Research-
of the lesion. The procedure was performed under local ers emphasize that this is a very effective and quick method
anesthesia. According to the researchers, the results were for treating VLs with good aesthetic results. It also spares
immediate, the healing process was uneventful, and full the mucosa overlying the lesion, proving the selectivity
recovery was reached after 4 weeks. After 18 months, no of this treatment option.13
recurrences were observed. This approach saves the mu-
cous membrane overlying the lesion as well as the sur- Photocoagulation using laser devices
rounding tissues, which proves the minimally invasive
properties of this method.11 Lasers are a very attractive therapeutic option in
The same method of treating VLs was described the treatment of vascular lesions. Their operation is based
by Weiss et al.13 This study included 8 patients with lip le- on the theory of selective photothermolysis, described
sions. The procedure was preceded by local anesthesia with by Anderson and Parrish. 30 They proved that tissue
4% lidocaine. Through a 30 G injection needle inserted chromophores can absorb specific wavelengths of light.
into the lesion, energy was delivered from a monopolar Hemoglobin contained in the residual blood in the di-
tip (McKesson 22-940™) with a power of 2 J. Immediate lated vessels is 1 of the 4 tissue chromophores. Its larg-
results were obtained with excellent cosmetic effects. After est absorption spectrum is in the range of 400–600 nm.
Adv Clin Exp Med. 2025 7

As the wavelength increases, its absorption decreases in 19.51% of patients, recovery was partial, with a reduction
significantly, and it reaches another absorption peak, of the lesion in the range of 75–95%. Only 1 patient required
much weaker than the 1st one, which is in the range of 3 sessions, 3 patients required 2 sessions, and the remaining
800–1,000 nm. The energy of the electromagnetic radia- patients only required 1 session. One patient had a slight
tion is absorbed by the hemoglobin and is further trans- scar after treatment. Recovery was uneventful for all pa-
formed into thermal energy, causing blood coagulation and tients. The authors underscored the safety and efficacy
damage to the vessels, leading to their closure. The selec- of this method for the treatment of VLs. However, being
tion of laser devices in the treatment of VLs should con- aware of the use of many other types of lasers in the treat-
sider the above properties of hemoglobin. Thanks to this, ment of these lesions, they believe that the alexandrite laser
the impact of the laser beam is selective and limited mainly requires comparison with other laser devices.16
to the vascular lesion itself.30 A different approach was reported by Yang et al., who
Azevedo et al. researched a group of 17 patients using used 2 lasers emitting wavelengths of 595 and 1,064 nm.17
an 808 nm diode laser (Lasering 808; Revivre Italia SpA, The study included 15 Asians with skin phototype IV
Milan, Italy) to treat VLs of the oral cavity.14 Exposure on the Fitzpatrick scale – a total of 17 VL lesions. Lo-
parameters were contactless mode, power of 2–3 W, opti- cal anesthesia was used optionally before the procedure.
cal fiber diameter of 300 µm, continuous wave operating First, a 595 nm pulse dye laser (PDL) was used, followed
mode, distance of the optical fiber from the lesion surface by a 1,064 nm Nd:YAG laser (Cynergy Multiplex; Cyno-
of 2–3 mm, average exposure time of 10 s, and an energy sure Inc., Westford, USA). During exposure, continuous
density of 20 J/cm2. The procedure was preceded by local air cooling was used (Cryo 5a; Zimmer Medizinsysteme
anesthesia and lasted until the lesion turned pale. If this GmbH, Neu-Ulm, Germany). The exposure parameters
result was not obtained, the procedure was repeated were as follows for the PDL laser: A spot diameter of 7 mm,
at 30-s intervals until successful to avoid overheating an energy density of 7–11.5 J/cm2 and a pulse of 2–10 ms.
of the tissues. During the first 2 days after the procedure, For the Nd:YAG laser, an energy density of 35–40 J/cm2
participants observed slight swelling and minimal pain and a pulse of 15–40 ms was used. The authors reported
in the treated area. Only 1 patient required painkillers. Af- that the selection of energy density was based on the color
ter 2–3 weeks, all patients reached full recovery after only of the lesion, and the pulse width was based on the pre-
1 session. Moreover, the recovery period was uneventful sumed diameter of the vessel. Applications of laser beams
in all patients, without scarring or discoloration. The study occurred consecutively without overlap. The treatments
authors emphasized that the contactless VL treatment were repeated monthly until the changes disappeared
technique using this laser is highly effective and simple.14 completely. Post-treatment, it was recommended to use
A different diode laser with a wavelength of 980 nm antibiotics (the study authors did not specify the type
(LiteMedics, Milan, Italy) was used by Voynov et al., who of antibiotic). After treatment, slight swelling was ob-
included a group of 35 patients.15 The procedure was pre- served, which disappeared after 2–3 days. Full recovery
ceded by superficial or infiltration anesthesia. The expo- was reached in 82.4% of patients after 1–2 sessions, while
sure was carried out in contactless mode with an optical 17.6% reached partial recovery after 1–3 sessions. In 1 case,
fiber diameter of 300 μm, continuous mode and a power after 3 sessions, an improvement of 80% was achieved,
of 2–3 W. The exposure parameters and exposure time with a recurrence of the lesion 1 year after the end of treat-
depended on the size of the VL and varied from 224 J/cm2 ment. The authors explained this therapeutic approach
at 2 W with a time of 20 s to 344 J/cm2 at 3 W for 60 s. by the fact that the absorption spectrum of hemoglobin
One session was sufficient for all patients to reach full coincided with the emission spectrum of both devices.
recovery. Postoperative pain was minor, and 1 patient ex- However, a 596 nm PDL penetrates tissues to a depth
perienced transient bleeding. Recovery was reached within of 1.5 mm, while the Nd:YAG 1,064 nm penetrates approx.
2–4 weeks. The results of these studies also indicate that 3.7–6.0 mm, which may result in the coagulation of vessels
selective photocoagulation of VLs using a 980 nm diode at various depths. The order in which the devices were used
laser is an effective and safe treatment method.15 was because the PDL 595 nm transforms oxyhemoglobin
Wang et al. used a 755 nm alexandrite laser (The Candela into methemoglobin, which absorbs 1,064 nm Nd:YAG la-
Gentle’s Alexandrite Laser; Candela Medical, Marlbor- ser radiation 3 times more than oxyhemoglobin. Therefore,
ough, USA) to treat VL lesions on the lips in 41 patients.16 it is possible to use lower energy densities of the 1,064 nm
The device was equipped with a Dynamic Cooling Device Nd:YAG laser while maintaining its effectiveness and re-
(DCD), and the area treated with the laser was covered with ducing side effects. The authors believe that this treatment
paper scarves with individually cut holes, exposing the le- method is effective and safe in Asians, although a lower
sion to avoid damaging adjacent tissues. The procedure energy density of the 1,064 nm Nd:YAG laser was used
was as follows: A spot width of 8 mm, pulse width of 3 ms than in studies conducted on Caucasian patients.17
and energy density of 50–90 J/cm2. After the procedure, A similar therapeutic approach was characterized
it was recommended to use erythromycin ointment for in the study by Roncero et al.18 They used 2 PDL lasers:
3 days. Full recovery was reached in 80.49% of patients, and 595 nm and a Nd:YAG 1,064 nm laser (Cynergy Multiplex)
8 Trafalski, K. Jurczyszyn. Venous lake treatment methods

to treat 39 VLs in 30 patients. Infiltration anesthesia was Chenung and Lanigan used a PDL 595 nm laser (Can-
used in 1/3 of patients (mepivacaine 2%). For irradiation, dela Vbeam; Candela Medical).20 They included 8 patients
a PDL laser of 595 nm, 20 ms, and 10 J/cm 2 was used in their study. The operating parameters of the laser de-
first, followed by a Nd:YAG laser of 1,064 nm, 20 ms vice were as follows: an energy density of 8.5–13.0 J/cm2,
and 70 J/cm 2 . The spot width in both cases was 7 mm. a spot diameter of 7 mm and a pulse length of 1.5 ms. Ad-
The procedures were performed under air cooling. After ditionally, they used cryogenic spray cooling. The number
the procedure, a 2% mupirocin ointment was applied topi- of therapeutic sessions ranged from 1 to 5. In subsequent
cally. Response to treatment was assessed after 3 months. treatment sessions, the energy density was increased
One therapeutic session was required in 89.75% of patients by 0.5–1.0 J/cm2. Only 2 patients had full recovery (25%),
and 2 sessions in the remaining patients. Full recovery and 1 had partial recovery (12.5%). The remaining pa-
was reached in 95% of patients. Among the side effects, tients did not respond to treatment, or the response was
the formation of a slight scar in 2 cases (5.12%) was ob- unsatisfactory. No complications were reported during
served. Researchers believe that the use of 595 nm PDL healing. Due to the unsatisfactory results, the researchers
and 1,064 nm Nd:YAG lasers provides a safe, rapid and ef- suggested pressing the lesion with a transparent glass dur-
fective treatment option for oral VLs. By using these lasers ing exposure to increase the depth of beam penetration,
in succession, better coagulation is achieved, especially as well as extending the pulse width, which could improve
in the case of deeper lesions.18 clinical results.20
A 1,064 nm Nd:YAG laser (Synchro FT Deka, MELA s.r.l., An argon laser (Coherent Medical Group, Palo Alto,
Calenzano, Italy) was also used in the study by Armogida USA) with blue and green light with a peak output power
et al.19 They examined a group of 47 patients with 50 VL of 488 nm and 514 nm was used by Neumann and Kno-
lesions. They carried out exposure to lesions in a contact- bler.21 The study included 51 patients with lip lesions.
less mode with exposure parameters of 100 J/cm2 , spot No anesthesia was used before the procedure except for
diameter of 2.5 mm and total emitted energy of 4.9 J us- 3 patients. The exposure parameters used a power of 1.8–
ing continuous operation mode. The procedure was not 3.0 W, a spot diameter of 1.5–2.0 mm and a pulse width
preceded by anesthesia. The exposure continued until of 300 ms. The healing period ranged 1.5–12 weeks. Pa-
the lesion turned gray, the exposure time ranging from tients were followed up for 18 months. Full recovery was
30 to 120 s. Only 1 treatment session was required for all reached in 98.03% of patients. Among the side effects, they
patients. Full recovery was reached in 47% of cases after observed scar formation in 10% of cases. One therapy ses-
7 days and after 30 days in all lesions. Patients rated peri- sion was required in 76.4%, 2 in 9.8%, 3 in 7.8%, and 4 ses-
procedural pain at 1.86 on a 4-point scale. However, after sions in 5.8% of participants. After 18 months of follow-up,
24 h, the pain level was 0. No complications were observed, 1 patient experienced a recurrence. According to research-
except for 1 case of small scar formation. The observation ers, the argon laser is a safe and effective therapeutic option
period was 2 years. This procedure was shown to be effec- for the treatment of VLs.21
tive and safe as it did not require anesthesia and resulted Further research using a 980 nm diode laser (Smart M;
in the complete healing of all lesions.19 Lasotronix, Piaseczno, Poland) was conducted by Trafalski
A 1,064 nm Nd:YAG laser (Power Laser TM ST6; Lares et al. This group included 23 patients.22 The procedure was
Research®, San Clemente, USA) was also used in the study preceded by local anesthesia with 10% lidocaine. Exposure
by Migliari et al.4 The study included 16 patients. The pro- parameters were a pulse mode, an output power of 6 W,
cedure was preceded by local anesthesia. The operating a pulse width of 100 ms, and a 50% duty cycle. In 83%
parameters of the laser device were as follows: a power of patients, 1 therapy session was required, and in 17%,
of 2W, pulse frequency of 50 Hz and exposure time 2 sessions were required. The modification of the method
of 10 s. Irradiation was performed in a contactless mode consisted of contactless exposure through a microscope
with a 320 μm diameter optical fiber placed at 2–3 mm slide placed with light pressure on the lesion to reduce its
from the lesion, using fast circular movements. The pro- vertical dimension and penetrate the beam deeper into
cedure was performed until the VL turned pale and de- the lesion. The healing assessment was based on an innova-
creased. If necessary, another cycle was performed after tive method of fractal dimension analysis (FDA), texture
30 s to prevent heat damage to the tissues. In all patients, analysis (TA) and graphic images of these changes taken
1 therapeutic session was enough to reach full recovery. before treatment and 1 and 12 weeks after treatment. Full
In all cases after treatment, investigators only observed recovery was reached in 83% of patients and scar formation
swelling of the treated area, which lasted 1–2 days. No was observed in 9%. In the remaining 4%, partial recovery
pain or bleeding was observed in any of them. The healing occurred, and in 4%, there was no response to treatment.
period was 2–4 weeks. After healing, none of the typical Researchers reported no side effects. They emphasized
side effects, such as scars, discoloration or hyperpigmen- that the use of a 980 nm diode laser is effective and safe
tation, were observed. Researchers demonstrate that this in the treatment of VLs. Moreover, they reported that FDA
technique provides safe and effective treatment of VLs and TA is a useful and objective method for assessing the ef-
in the oral cavity with clear results.4 fects of the treatment for these lesions using a diode laser.22
Adv Clin Exp Med. 2025 9

Photocoagulation with infrared light Sclerotherapy

This method uses an infrared coagulator that emits inco- This is a therapeutic method that involves closing a frag-
herent radiation in the range of 400–2,500 nm. The maxi- ment or longer section of a vein or artery by administering
mum output power of the device is in the infrared spec- an appropriate substance causing obliteration. The mecha-
trum. The radiation is delivered through optical fibers nism of action of sclerosing substances is to react with
to a quartz tip, which is applied directly to the lesion being the vascular endothelium, bringing about its destruc-
treated, causing tissue heating and coagulation. The dose tion.3,33 The effect on the endothelium additionally leads
of emitted energy can be adjusted in terms of power and to the formation of a plug made of dead endothelial cells,
pulse length. Coagulators can typically generate pulses fibrin and blood elements. The plug is firmly attached
in the range of 0.5–3 s. The coagulation depth is sev- to the wall of the obliterated vessel, which prevents it from
eral millimeters and is approximately equal to the pulse traveling along with the blood flow. As a result, the ves-
duration. However, pulses longer than 3 s cause charring sel lumen is closed and filled with fibrous connective
and burning of tissues. This device provides excellent tissue. 34,35 The most commonly used sclerosing agents
hemostasis without the release of gases that are present include hypertonic glucose solution, alcohol (ethanol),
when using laser surgery or electrocoagulation. Infrared ethanolamine oleate (EO), bleomycin, polidocanol, sodium
light photocoagulation is used to treat various lesions, tetradecyl sulfate (STS), and OK-432.36 However, it is still
such as hemorrhoids, condylomas and benign cervical le- unknown which sclerosing agent is best in terms of effec-
sions.31,32 It is also a therapeutic option in the treatment tiveness and safety. Sclerotherapy is used primarily to treat
of VLs located in the oral cavity. venous and lymphatic diseases, telangiectasias, esopha-
Colver and Hunter treated 9 patients with a total of 10 VL geal varices, hemorrhoids, and varicose veins.36–39 It may
lesions using an infrared coagulator (Model IRK 151, also be considered a therapeutic option for VLs located
MBBAT; Lumatec GmbH, Deisenhofen, Germany) with in the oral cavity. Due to their low costs and satisfactory
a quartz tip diameter of 6 mm.23 The therapy was preceded results, this therapeutic approach is widely practiced.
by local anesthesia in the form of 1% lidocaine hydrochlo- Fernadez et al. conducted a study on a group of 33 pa-
ride. Before activation, the sapphire tip was applied with tients using 5% ethanolamine oleate (EO) (Ethamolin;
light pressure to the lesion to empty it of residual blood. Zest Pharma Ltda., Rio de Janeiro, Brazil).24 The volume
The treatment was performed with 1 pulse lasting 1.125 s. of the solution was calculated based on the diameter
After 2–3 weeks, full recovery of all lesions was observed, of the lesion: 0.1 mL/1 mm of lesion diameter. The total vol-
but in 2 patients, a small depression occurred in the treated ume ranged from 0.3 mL to 0.9 mL. Before the procedure,
area. After 4 months, no recurrences were noted. In all infiltration anesthesia with a vasoconstrictor was used.
cases, only 1 treatment session was required. The authors One therapy session was required in 85% of patients, and
suggested that in subsequent studies, the pulse duration in the remaining cases, 2 sessions were needed. The pro-
should be shortened to 1 s to minimize the complications cedure was repeated after 3 weeks in cases where 1 ses-
they noted in 2 cases. Researchers consider this method sion was insufficient to obtain satisfactory results. The size
effective, quick and safe in the treatment of VLs.23 of the treated lesions ranged from 3 to 10 mm. Complica-
Ah-Weng et al. treated 18 patients with 20 VL lesions tions in the form of scarring and discoloration were not
on the lips using an infrared coagulator (IRK151; Lu- reported, but most patients reported some discomfort after
matec).10 The procedure was preceded by local infiltration the application of the sclerosing agent, such as pain, swell-
anesthesia with adrenaline, and the tip was placed with ing, redness, and burning, which lasted from 1 to 3 days.
slight pressure on the lesions to empty them of residual Healing of the lesions occurred within 2–6 weeks. In all
blood. The number of pulses ranged from 2 to 4. The ini- cases, there was a complete regression of the changes, and
tial infrared pulse had a length of 1 s with subsequent observations were carried out for 3–6 months after the pro-
pulses being increased by 0.125 s, reaching a maximum cedure. The authors’ conclusions support that sclerotherapy
value of 1.5 s. The procedure continued until the lesion with EO is an effective, inexpensive and predictable method
faded, along with a 2-mm margin around the VL. Patients for the treatment of VLs on the lips in elderly patients.24
were observed for 3–6 months after the end of treatment, Kuo and Yang used 1% polidocanol in 2 patients with VLs
with an average of 3 months. Full recovery was reached on the upper lip.25 They injected the sclerosing agent into
in 16 cases, and in 4 cases, partial recovery was reached the lesion using a needle and insulin syringe. The volume
with the formation of a slight scar at the treatment site. of sclerotization was 0.6–1.0 mL. The preparation was
In 17 cases, 1 therapeutic session was sufficient, in 2 cases, administered until the residual blood was removed from
2 sessions, and in 1 case, 3 sessions were required. No the lesion; then, the researchers applied 10 min of pres-
healing complications were observed, except for 3 cases sure to the treated area. The changes disappeared after
of postoperative bleeding. The observations of the authors 2 sclerotherapy sessions. The healing period was 4 weeks.
of this study show that this method is effective, resulting In 1 case, an inconspicuous scar and hyperpigmenta-
in good therapeutic and cosmetic effects.10 tion occurred. The observation period was 6 months.
10 Trafalski, K. Jurczyszyn. Venous lake treatment methods

The authors believed that sclerotherapy with this agent the most frequently chosen therapeutic option for these le-
is efficacious and represents a viable alternative to other sions is photocoagulation using various laser devices. Their
therapeutic methods for treating VLs.25 usefulness is supported by ease of use, good treatment re-
Another group of 25 patients with lip lesions treated with sults and a small number of adverse effects. The lasers used
1% polidocanol was described by Cebeci et al.26 The volume in this area included a PDL 595 nm, diode laser 980 nm,
of the sclerosing agent was calculated based on the diameter diode 808 nm, Nd:YAG 1,064 nm, alexandrite laser 755 nm,
of the lesion – 0.1 mm3/1 mm of lesion diameter. The agent and argon laser with peak output powers of 488 nm and
was administered using a syringe and insulin needle un- 514 nm. According to the theory of selective photothermoly-
til the blood was emptied from the lesion. Then, pressure sis, their highly effective results are attributed to the perfect
was applied for 5 min. All changes regressed completely. absorption of the emitted electromagnetic radiation by a tis-
The healing period was 2–4 months. The follow-up period sue chromophore, which is hemoglobin.30 It absorbs the la-
was 6 months from the last treatment. Only 1 session was ser energy and turns it into heat, which is then transferred
required in 32% of patients, 2 sessions in 28%, 3 sessions to the walls of the vessels, causing them to coagulate and
in 24%, 4 sessions in 8%, and 5 sessions in 8%. The num- close. Thanks to this, laser surgery is becoming the gold
ber of sessions depended on the size of the VL. In the case standard for the treatment of minor vascular lesions. Due
of a diameter not exceeding 3 mm, the number of sessions to the greatest absorption of radiation in the range of 400–
ranged from 1 to 2. For lesions with a diameter of 4–6 mm, 600 nm by hemoglobin molecules, devices such as PDL
the number of sessions ranged from 1 to 4. However, 595 nm and argon lasers of 458 nm or 514 nm should be pro-
in the case of lesions with a diameter of 7–8 mm, 3–5 thera- moted.40 However, the depth with which the beam of these
peutic sessions were required. The interval between subse- devices penetrates the tissues is only 1.5–2.0 mm, cover-
quent sessions was 3 weeks. In 2 cases, minor scarring and ing only superficial changes. It should also be noted that
discoloration occurred. The adverse effects included local this wavelength of light is absorbed by melanin much more
angioedema in 2 cases. Cebeci et al. emphasized that this strongly than near-infrared radiation. This is important
treatment method is both effective and simple, with excel- when the treated lesions are on the verge of the lips and in pa-
lent therapeutic and cosmetic results.26 tients with a dark complexion. This may result in a greater
Jung et al. included 12 patients with 13 lesions on the lips risk of skin damage if a VL is on the lips. Especially in these
in a study using 0.5% STS.27 The size of the lesions ranged patients, devices emitting radiation in the near-infrared
from 2 to 10 mm. To establish the correct diagnosis, a 2 mm range should be preferred to limit epidermis damage and
punch biopsy was performed before treatment. The biopsy complications such as skin discoloration. It should be re-
material was assessed by histopathological examination. membered that as the wavelength increases, the laser beam
The sclerosing agent was injected slowly into the lesion penetrates deeper into the tissues, which significantly im-
using a needle and insulin syringe until it was emptied proves the treatment of larger or deeper lesions. Therefore,
of residual blood. Then, alternating pressure was applied diode lasers emitting radiation at 808 nm and 980 nm and
for 10 min. The volume of this agent was 0.05–0.20 mL. Nd:YAG 1,064 nm, whose emission spectrum is less ab-
Patients were followed up after 2 weeks, and the treatment sorbed by hemoglobin than the emission spectrum of la-
was repeated until the lesion disappeared completely. All sers emitting shorter wavelengths, provide better results
patients reached full recovery. In 32% of patients, only in the treatment of VLs. An interesting solution is the use
1 session was required. In 28% of patients, 2 sessions were of lasers with different emitted wavelengths – PDL 595 nm
sufficient. In 24% of patients, 3 sessions were necessary. with a Nd:YAG 1,064 nm laser. The justification for this
Eight percent of patients required 4 sessions and 8% of pa- method is the previously mentioned fact of a different
tients required 5 sessions. The recovery period ranged depth of tissue penetration and the electromagnetic radia-
between 2–12 weeks. The mean follow-up period was tion emitted by them. In addition, the PDL 595 nm laser
29.58 months (10–49 months). No complications, such used as the first one converts oxyhemoglobin into methe-
as necrosis, hyperpigmentation, swelling, or inflamma- moglobin, which has 3 times the absorption of 1,064 nm
tion, were observed. Moderate pain and paresthesia during ND:YAG laser radiation than normal blood. This effect
injection were observed in some patients but disappeared allows the use of lower energy densities of the 1,064 nm
quickly. The authors emphasized that the above method Nd:YAG laser, maintaining its effectiveness and reducing
was effective and acceptable to patients.27 the risk of side effects.41 However, the test results do not
confirm that this option is significantly more effective than
using only the 1,064 nm Nd:YAG laser.
Discussion Analyzing the treatment results, the best results were
obtained using an 808 nm diode laser and a 1,064 nm
Therapeutic options for VLs that occur in aesthetically Nd:YAG laser, reaching full recovery in all treated le-
sensitive areas should primarily include a minimally inva- sions.4,14,19 The use of a 980 nm diode laser was charac-
sive approach and highly cosmetic treatment results. Based terized by full recovery in 83–100% of lesions,15,22 an argon
on the data collected in this review, it can be concluded that laser with a peak output power of 488 nm and 514 nm
Adv Clin Exp Med. 2025 11

in 98.03%,21 an alexandrite laser 755 nm in 80.49%,16 and increasing the precision of the procedure and preventing
a PDL 595 nm in 25% of cases.20 The use of a 595 nm PDL the formation of scars. Despite very good treatment re-
laser with a 1,064 nm Nd:YAG laser resulted in a full recov- sults, it is difficult to consider it as the method of choice
ery rate of 82.4–95.0%.17,18 The above data support a higher in the treatment of VLs in the oral cavity. This is because
effectiveness of devices emitting radiation in the near-in- the number of therapy sessions needed to reach full re-
frared range, even though hemoglobin is characterized covery ranges from 1 to 3. Moreover, researchers using
by a lower absorption of radiation in this range. However, it have observed complications in the form of depressions
it is difficult to compare the results of studies conducted at the treatment site, which is undesirable in the case of aes-
using different lasers. This is due to the different num- thetically sensitive areas. Clinicians using this method
ber of treated patients and the use of different radiation suggest shortening the pulse length to 1 s to improve its
parameters. Moreover, the lesions treated varied in size, effectiveness and minimize side effects. Therefore, further
which may additionally influence the treatment results. research in this direction, especially on larger numbers
Therefore, further research on the standardization of irra- of patients, should be conducted.
diation parameters of VLs is of key importance in this field. The least frequently used treatment method for oral
The 2nd most common therapeutic option for the treatment VLs is electrocoagulation. In the analyzed studies, it was
of oral VLs is sclerotherapy. The most used agents are 1.0% modified by introducing a needle into the lesion, to which
polidocanol, 5.0% EO and 0.5% STS. The research results an active monopolar diathermy electrode was applied.11,13
indicate that this is a simple, very effective and inexpensive Thanks to this, the energy of the device is transferred di-
treatment method. A VL is considered to be a low-flow lesion. rectly to the interior of the lesion, which provides the se-
Therefore, injecting a sclerosing agent inside the VL allows lective nature of this technique. This procedure allows
the achievement of a therapeutic concentration, resulting you to save the surrounding mucosa, which is confirmed
in an appropriate response to treatment. Sclerosing agents by the results of the conducted research. Moreover, using
such as polidocanol, EO and STS are characterized by low this method, it is possible to reach full recovery of lesions
toxicity. However, it should be remembered that when using with only 1 therapeutic session. Such results were obtained
them, side effects may occur, such as tissue necrosis, allergic only when using an 808 nm diode laser and a 1,064 nm
reactions or discoloration. In studies using these agents, full Nd:YAG laser. Additionally, no side effects were observed
recovery was reported in all cases, which is only possible using this technique. Therefore, this therapeutic option
when using a 1,064 nm Nd:YAG laser and an 808 nm di- can be considered the method of choice in the treatment
ode laser and electrocoagulation. However, complications of VLs in the oral cavity. However, the small number
in the form of scaring and hyperpigmentation were more of patients treated with this method does not allow us
common than complications when using diode 808 nm lasers, to clearly state that it is as effective as photocoagulation
Nd:YAG 1,064 nm lasers and electrocoagulation. Moreover, with an 808 nm diode laser and Nd:YAG.
for sclerotherapy, the number of therapeutic sessions neces- It is also worth mentioning that the assessment of the re-
sary to reach full recovery is much larger and ranges from sults of the healing of VLs may be influenced by the bias
1 to 5. Therefore, this may encourage clinicians to use other, of the researchers or the inaccuracy of the assessments.
more effective methods that require fewer treatment ses- There are no qualitative and fully objective methods for
sions. This discrepancy is primarily due to the different sizes assessing the healing of VLs. Subjective scar assessment
of the lesions treated and the agents used. Analyzing the re- scales are used, such as The Stony Brook Scar Evalua-
sults of sclerotherapy, it appears that as the size of the VL in- tion Scale (SBSES), Manchester Scar Scale (MSS), Patient
creases, the number of sessions needed to reach full recovery and Observer Scar Assessment Scale (POSAS), and Van-
may increase. This is particularly visible in the cases using couver Scar Scale (VSS).42,43 It is worth mentioning that
1.0% polidocanol and 0.5% STS, where the number of sessions Trafalski et al. took up such a challenge using TA and
increased significantly with the increased size of the lesion FDA on graphic images of the treated lesions.22 They ana-
and ranged from 1 to 5 sessions.25–27 However, for 5% EO, lyzed photographs of VLs before the procedure, 7 days,
the number of sessions ranged from 1 to 2, which indicates and 3 months after the procedure to monitor the heal-
that the size of the treated lesions has a much smaller impact ing process. Additionally, after 3 months, they compared
on this factor.24 Therefore, the use of 5.0% EO is more ben- the healed areas with the adjacent healthy mucosa, which
eficial than 1.0% polidocanol and 0.5% STS. served as a control group for the treated lesions. Their
Another method, less frequently used, is photocoagula- results were based on the mathematical analysis of digital
tion with infrared light.10,23 The emitted incoherent infra- images, which made them free from subjective assessment.
red radiation results in similar results to the use of laser The authors emphasize that FDA and TA are useful and
devices. Full recovery in the analyzed studies was reached objective methods for assessing the effects of diode laser
in 80–100% of cases. It is a contact technique, and an im- treatment of VLs, which should encourage other clinicians
portant element of it is compressing the lesion before ir- to use it when evaluating other treatment options.
radiation to empty it of residual blood. This minimizes Analyzing the research results in this review, it was
the energy needed to coagulate pathological vessels, thus shown that the most effective therapeutic options for
12 Trafalski, K. Jurczyszyn. Venous lake treatment methods

the treatment of VLs in the oral cavity are electrocoagu- developed yet. Since this is not an uncommon clinical
lation, photocoagulation with an 808 nm diode laser, and problem, knowledge of treatment techniques is essential
Nd:YAG.4,11,13,14,19 This is supported by reaching full recov- to improve this area of oral surgery.
ery in all treated cases using only 1 therapeutic session.
Another equally effective method is sclerotherapy using Limitations
1.0% polidocanol, 0.5% STS and 5.0% EO.24–27 Full recovery
was reached in all cases; however, the number of treatment The above publications are narrative in nature and may
sessions ranged from 1 to 5 for 1.0% polidocanol and 0.5% be characterized by the authors’ bias. However, such re-
STS.25–27 In contrast, 5.0% EO required only 1–2 therapeu- views are of great value for the development of scientific
tic sessions.24 Additionally, side effects in the form of scar- and clinical concepts. Due to the small number of studies
ing and discoloration are much more common than with on the treatment of VLs located in the oral cavity, it is im-
other methods. This may make sclerotherapy less attrac- possible to perform a reliable systematic review.
tive compared to the previously mentioned options. In the case of lesions treated with a laser, some of the pub-
Considering the healing period of VLs treated with lications do not describe all the parameters characterizing
lasers, it ranged from 2 to 16 weeks. The shortest time the laser beam, which makes it impossible to repeat the ex-
was 2–3 weeks in the case of an 808 nm diode laser14 and periment and objectively compare the results.
an argon laser with a peak output power of 488 nm and The topic of the treatment of VLs located in the oral
514 nm.21 For other devices, the healing period was as fol- cavity is not widely described. There are only few stud-
lows: for the 980 nm diode laser it was 2–12 weeks,15,22 ies on this topic written after 2020. In order to provide
for the Nd:YAG 1064 nm it was 4 weeks,4,19 and for the most comprehensive account possible, we have drawn
the PDL 595 nm with Nd:YAG it was 4–16 weeks.15,16 upon the existing literature on this subject.
This is another factor that favors the greatest effective-
ness of the 808 nm diode laser, the argon laser with a peak
output power of 488 nm and 514 nm, and the Nd:YAG Conclusions
1064 nm laser. However, in the case of the argon laser,
the number of treatment sessions ranged from 1 to 5,21 and Venous lakes in the oral cavity are mainly an aesthetic
for the 808 nm diode and Nd:YAG lasers, only 1 session problem, negatively affecting the quality of life of patients.
was required.4,14,19 Considering the ratio of full recovery Modern methods of treating VLs of the oral cavity are
to the number of necessary treatment sessions, the 808 nm characterized by low invasiveness and are safe and effec-
diode laser and Nd:YAG are characterized by the high- tive, which is why they are promoted among clinicians
est effectiveness. Referring to other methods, the healing instead of surgical excision. Among modern methods
time is 2–16 weeks for sclerotherapy,24–27 there is no data of treating VL in the oral cavity, only sclerotherapy, elec-
for electrocoagulation, and for photocoagulation with in- trocoagulation and photocoagulation with an 808 nm and
frared light, it is 2–3 weeks, but no data were available Nd:YAG 1,064 nm diode laser are 100% effective. Regard-
in the analyzed studies. less of the method chosen, patients should be informed
The most common adverse effects of all laser devices about potential side effects associated with their use, such
included minor swelling that disappeared after 2–3 days, as slight postprocedural pain and swelling, bleeding and
moderate pain after the procedure, bleeding, and the for- paresthesias. Additionally, the possibility of leaving scars
mation of minor scars at the treatment site. Lack of re- should be considered.
sponse to treatment was noted in the case of a diode laser In the opinion of the authors of this review, it cannot be
980 nm – 4%,22 and a PDL 595 nm laser – 65%.20 In 1 study, clearly stated which method of treating VLs in the oral cav-
researchers employed photocoagulation with infrared light ity is best due to the small number of publications on this
and reported a 20% complication rate in the form of de- topic. Research reports support the use of 808 nm and
pression at the surgical site.23 In the case of sclerother- Nd:YAG 1,064 nm diode lasers and electrocoagulation.
apy, the most common adverse effects are bleeding after In these cases, the response to treatment reached 100%
the procedure, short-term pain and local swelling, but also with only 1 treatment session. However, it should be men-
angioedema. In the case of electrocoagulation, the authors tioned that the cost of these devices may be a limitation
did not identify any adverse effects. and can encourage the selection of other cheaper methods.
Authors should discuss the results and how they can be Therefore, sclerotherapy using 5% EO may be an attractive
interpreted from the perspective of previous studies and treatment option due to its low costs, 100% effectiveness
the working hypotheses. The findings and their implica- and the small number of therapeutic sessions necessary
tions should be discussed in the broadest context possible. to reach full recovery.
Future research directions may also be highlighted.
There are few studies and articles in the scientific lit- ORCID IDs
erature regarding the treatment of VLs in the oral cav- Mateusz Trafalski  https://orcid.org/0000-0002-7643-9664
ity. Additionally, their treatment protocol has not been Kamil Jurczyszyn  https://orcid.org/0000-0002-0667-7261
Adv Clin Exp Med. 2025 13

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