In the current classification of vascular anomalies , it is classified into two broad biologic categories : vascular tumors and vascular malformations . <br/><br/>Vascular tumors have increased endothelial cell turnover and undergo mitosis. They grow disproportion to the child. Vascular tumors are subdivided on the basis of presence or absence of endothelial cell glucose transporter 1 (GLUT1) isoform protein.<br/>Infantile hemangiomas and angiosarcomas express GLUT1 protein, whereas congenital hemangiomas and kaposiform hemangioendotheliomas do not . <br/><br/>In contrast, malformations are not tumors and thus do not exhibit increased endothelial cell turnover.<br/>They are defined as structural abnormalities that grow in proportion to the child .<br/>Vascular malformations are subdivided into slow-versus fast- flow malformations.<br/>Slow-flow malformations include various combinations of venous, capillary, and lymphatic elements, whereas fast-flow malformations must contain an arterial component . <br/><br/>Vascular tumors<br/>a. Infantile hemangioma<br/>b. Congenital Hemangioma<br/>c. Kaposiform hemangioendothelioma and Tufted angioma <br/>d. Angiosarcoma <br/><br/>Vascular malformations<br/>a. Slow Flow : Capillary , Venous , Lymphatic or combined <br/>b. Fast Flow : Arteriovenous malformation<br/>c. Mixed <br/><br/>This system allows more consistent and accurate diagnoses as well as long term outcome and treatment options<br/>.i.e. Oral Propanolol is only for infantile hemangioma , topical Timolol for superficial hemangioma and Oral Sirolimus is considered for Kaposiform hemangioendothelioma and lymphangioma. It has been widely embraced by clinicians and radiologists who most often deal with vascular anomalies.

Facial telangiectasis has been predominantly and effectively treated with dye lasers for a long time. However, failure to remove chromophore poor small vessels or high pressure vessels and purpura formation at treated areas make vessels clearance at treated areas incomplete, fluctuating and easily recurring. High hemoglobin absorption wavelength of 532 nm with large spot size and delicate pulse duration setting may easily disrupt various size of vessels at different skin levels at one session with designed multilayer approach which is proposed as the term: vascular resurfacing. The concept of vascular resurfacing increases success in removing more telangiectasia with its connecting plexus at single treatment.

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Background<br/>Vascular lesions present a challenge to the dermatologist because of the large range of anatomical characteristics, especially regarding the deeper-sited vessels. A new long-pulsed KTP (LP-KTP) 532 nm/1064 nm system has been developed which offers macropulses comprising a single pulse (formerly termed continuous wave), sub-micro (300 µs) or sub-milli (1.5 ms) subpulses at both 532 nm and 1064 nm with adjustable cryocooling.<br/>Objective<br/>To demonstrate the enhanced ability offered by this new system to treat a number of vascular lesions existing at a variety of depths, both on and off the face.<br/>Materials and Methods<br/>Treatments are presented with the new LP-KTP 532 system of examples of port-wine stains (on and off the face), telangiectasia and pigmented scars using the optimum parameters for each lesion type as developed by the author, including the desired treatment endpoints.<br/>Results<br/>Good to excellent clearance in all lesion types was achieved in 1 to 6 sessions, 2-6 weeks apart. Some transient purpura, edema and erythema were seen, but no unexpected adverse events were reported, and patient satisfaction was universally very high with improved facial skin tone also being an additional benefit.<br/>Conclusions<br/>The new LP-KTP 532 system offered a safe and effective approach for clearance of a variety of vascular lesions with vessels at different depths. As parameters are fine-tuned and further developed, even greater efficacy can be expected with long-lasting results.

In daily clinical practice, dermoscopy is often used primarily for the diagnosis of pigmented skin malignancies such as melanoma. However, this presentation will focus on the dermoscopic evaluation of red lesions. When a lesion appears red on human skin, this is primarily due to hemoglobin within red blood cells. The hemorrhage and capillary dilation in the upper dermis appear bright red, but as the depth increases, the color shifts to a red blue to purplish-red. This phenomenon is believed to occur because the red color of hemoglobin decreases in saturation as it becomes more distant from the skin surface.<br/>The following topics of red lesion will be discussed using cases experienced at our institution:<br/>1. Strawberry pattern and inverse strawberry pattern in actinic keratosis and discoid lupus erythematosus<br/>2. Dermoscopic findings of vascular tumors and vascular malformations based on ISSVA classification<br/>3. Dermoscopic findings in pyogenic granuloma and amelanotic melanocytic lesions <br/>4. Characteristic glomerular vessels in Bowen's disease and the impact of topical steroids<br/><br/>(Key words, dermocopy, vascular findings, amelanotic melanoma)