Laser treatment of vascular lesions requires an understanding of the variety of vascular lesions as well as the available vascular lasers. The more commonly occurring cutaneous vascular lesions can be divided into a few categories: hemangiomas, vascular malformations, telangiectasias, and pyogenic granulomas. The natural history and treatment of these lesions varies, depending on the diagnosis.

Although a minority of hemangiomas are present at birth, the majority usually appear shortly after birth and grow for a limited time (Marler and Mulliken 2001; Mulliken et al. 2000; Mulliken and Glowacki 1982; Bautland 2006). Usually by eighteen to twenty-four months of age, hemangiomas will stop growing. Currently it is believed that hemangiomas develop as a result of in utero implantation of placental cells into the fetus (Phung et al. 2005), and most hemangiomas will subsequently regress spontaneously.

However, it takes years for this to occur. During this time, children can be subject to teasing from their peers. Frequently, even after regression, there will still be visible residual changes in the skin. If treated early, many of these hemangiomas will respond to treatment with a vascular laser such as a pulsed dye laser. In response to the laser treatment, some of the hemangiomas will stop proliferating, and some will regress.

Considering this, when possible, and depending on the particulars of the hemangioma and the patient, the first author recommends initiating treatment during the first few months of age.