{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T23:02:32Z","timestamp":1790377352598,"version":"4.1.0"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"10","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rofo"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Sclerotherapy remains the standard for interventional treatment of slow-flow vascular malformations. However, bleomycin electrosclerotherapy (BEST) has shown promising results in the management of recurrent lesions. One notable adverse effect of BEST is the postinterventional development of skin hyperpigmentation. The aim of this study is the analysis of accidental skin hyperpigmentation after BEST of slow-flow vascular malformations.<\/jats:p>\n                  <jats:p>This retrospective study at our interdisciplinary vascular anomalies center investigated the occurrence of skin hyperpigmentation after bleomycin electrosclerotherapy of slow-flow vascular malformations over a period of 21 months documented clinically and in photographic findings, as well as related interventional treatment parameters with subsequent exploratory threshold analyses at 0.10 and 0.15 mg\/kg. Subsequently, a comparison was made with recent publications reporting hyperpigmentation after bleomycin administration.<\/jats:p>\n                  <jats:p>During the observation period, 72 patients were included with a total of 80 BEST procedures. Bleomycin-related skin hyperpigmentation was documented in 4 of 7 lymphatic malformation (LMs), 20 of 44 venous malformation (VM)and in 16 of 29 combined venolymphatic vascular malformations associated with other anomalies. On average, 27.1 application series of reversible electroporation per intervention were performed (range 1\u201385).<\/jats:p>\n                  <jats:p>An average of 8.37 mg bleomycin was administered to LMs, 5.31 mg to VMs and 8.03 mg to the combined group in each session. Hyperpigmentation was more frequent with the hexagonal electrode: 33\/56 (58,9 %); Needle-Foil Electrode (NFD) 6\/19, Variable Geometry Device (VGD) 1\/5. Rates were similar across entities (hexagonal: LM 3\/5, VM 17\/31, combined 13\/20). Overall, bleomycin was administered intralesional 46 times with an average dose of 0.09 mg\/kg bw (range 0.008\u20130.23) and intravenously 34 times, 0.22 mg\/kg bw (range 0.13\u20130.5). Hyperpigmentation was more frequent after intravenous administration (61.8 %) than intralesional (41.3 %), likely reflecting higher dosing. A threshold dose of \u22650.10 mg\/kg bleomycin was associated with a higher risk ratio for hyperpigmentation (RR 2.30, 95% CI 1.27\u20134.15).<\/jats:p>\n                  <jats:p>The frequency of skin hyperpigmentation following BEST seems to be analog to bleomycin-induced flagellate dermatitis and appears more frequently when using the hexagonal electrode and a higher bleomycin dosage per kg bodyweight (bw).<\/jats:p>","DOI":"10.1055\/a-2783-4420","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T23:36:41Z","timestamp":1770421001000},"page":"1302-1309","source":"Crossref","is-referenced-by-count":0,"title":["Bleomycin Electrosclerotherapy and Skin Hyperpigmentation in Slow-flow Vascular Malformations: A Retrospective Monocentric Analysis"],"prefix":"10.1055","volume":"198","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8644-690X","authenticated-orcid":false,"given":"Julius Henry","family":"Loeser","sequence":"additional","affiliation":[{"name":"University Hospital Halle, Sachsen-Anhalt, Germany","place":["Halle (Saale)"],"department":["University Hospital and Polyclinic for Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Schramm","sequence":"additional","affiliation":[{"name":"University Hospital Halle, Sachsen-Anhalt, Germany","place":["Halle (Saale)"],"department":["University Hospital and Polyclinic for Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrix Rita","family":"Cucuruz","sequence":"additional","affiliation":[{"name":"University Hospital Halle, Sachsen-Anhalt, Germany","place":["Halle (Saale)"],"department":["University Hospital and Polyclinic for Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Gussew","sequence":"additional","affiliation":[{"name":"University Hospital Halle, Sachsen-Anhalt, Germany","place":["Halle (Saale)"],"department":["University Hospital and Polyclinic for Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Stadie","sequence":"additional","affiliation":[{"name":"University Hospital Halle, Sachsen-Anhalt, Germany","place":["Halle (Saale)"],"department":["University Clinic and Polyclinic for Dermatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilit","family":"Fl\u00f6ther","sequence":"additional","affiliation":[{"name":"University Hospital Halle, Sachsen-Anhalt, Germany","place":["Halle (Saale)"],"department":["University Clinic for Anesthesiology and Operative Intensive Care Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olena","family":"Kaluheresku","sequence":"additional","affiliation":[{"name":"University Hospital Halle, Sachsen-Anhalt, Germany","place":["Halle (Saale)"],"department":["University Hospital and Polyclinic for Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Schob","sequence":"additional","affiliation":[{"name":"University Hospital Halle, Sachsen-Anhalt, Germany","place":["Halle (Saale)"],"department":["University Hospital and Polyclinic for Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter A","family":"Wohlgemuth","sequence":"additional","affiliation":[{"name":"University Hospital Halle, Sachsen-Anhalt, Germany","place":["Halle (Saale)"],"department":["University Hospital and Polyclinic for Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1097\/00006534-198203000-00002","article-title":"Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics","volume":"69","author":"JB Mulliken","year":"1982","journal-title":"Plast Reconstr Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e113","DOI":"10.1097\/JOVA.0000000000000113","article-title":"Updated Classification of Vascular Anomalies. A living document from the International Society for the Study of Vascular Anomalies Classification Group","volume":"6","author":"DC Goldenberg","year":"2025","journal-title":"J Vasc Anom (Phila)"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1055\/a-0620-8925","article-title":"Vascular Anomalies (Part I): Classification and Diagnostics of Vascular Anomalies","volume":"190","author":"M Sadick","year":"2018","journal-title":"Rofo"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1016\/j.bjoms.2017.10.002","article-title":"Bleomycin electrosclerotherapy: New treatment to manage vascular malformations","volume":"55","author":"L McMorrow","year":"2017","journal-title":"Br J Oral Maxillofac Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1016\/j.jvsv.2020.09.009","article-title":"Bleomycin electrosclerotherapy in therapy-resistant venous malformations of the body","volume":"9","author":"WA Wohlgemuth","year":"2021","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"421","DOI":"10.3233\/CH-221683","article-title":"Individualized treatment of congenital vascular malformations of the tongue","volume":"83","author":"M Guntau","year":"2023","journal-title":"Clin Hemorheol Microcirc"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1007\/s00270-024-03693-1","article-title":"Interdisciplinary Treatment of Macroglossia Due to a Microcystic Lymphatic Malformation with Bleomycin Electrosclerotherapy Followed by Partial Resection","volume":"47","author":"JH Loeser","year":"2024","journal-title":"Cardiovasc Intervent Radiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"469","DOI":"10.2478\/raon-2024-0061","article-title":"Current Operating Procedure (COP) for Bleomycin ElectroScleroTherapy (BEST) of low-flow vascular malformations","volume":"58","author":"T Muir","year":"2024","journal-title":"Radiol Oncol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/s0305-7372(03)00073-2","article-title":"Electrochemotherapy: Results of cancer treatment using enhanced delivery of bleomycin by electroporation","volume":"29","author":"A Gothelf","year":"2003","journal-title":"Cancer Treat Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"6425","DOI":"10.1007\/s00330-024-10723-6","article-title":"Outcome of bleomycin electrosclerotherapy of slow-flow malformations in adults and children","volume":"34","author":"VF Schmidt","year":"2024","journal-title":"Eur Radiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1007\/s00270-020-02420-w","article-title":"Fatal Lung Toxicity After Intralesional Bleomycin Sclerotherapy of a Vascular Malformation","volume":"43","author":"AL Cho","year":"2020","journal-title":"Cardiovasc Intervent 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sclerosis-Case report and brief review","volume":"35","author":"C Pinto","year":"2018","journal-title":"Pediatr Dermatol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"68","DOI":"10.2165\/11537080-000000000-00000","article-title":"Flagellate dermatitis as a bleomycin-specific adverse effect of cytostatic therapy: A clinical-histopathologic correlation","volume":"12","author":"M Ziemer","year":"2011","journal-title":"Am J Clin Dermatol"},{"key":"ref20","first-page":"106","article-title":"\u201cFlagellate\u201d erythema from bleomycin. With histopathological findings suggestive of inflammatory oncotaxis","volume":"180","author":"P Cortina","year":"1990","journal-title":"Dermatologica"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1111\/j.1365-2133.2006.07474.x","article-title":"Bleomycin and the skin","volume":"155","author":"T Yamamoto","year":"2006","journal-title":"Br J Dermatol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1067\/mjd.2002.119195","article-title":"Delayed bleomycin-induced hyperpigmentation and pressure on the skin","volume":"46","author":"GE vonHilsheimer","year":"2002","journal-title":"J Am Acad Dermatol"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"D Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016401","article-title":"Electrosclerotherapy for capillary malformations: Study protocol for a randomised within-patient controlled pilot trial","volume":"7","author":"SER Horbach","year":"2017","journal-title":"BMJ Open"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1097\/DSS.0000000000003220","article-title":"Bleomycin Electrosclerotherapy Treatment in the Management of Vascular Malformations","volume":"48","author":"M Kostusiak","year":"2022","journal-title":"Dermatol Surg"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2025.162631","article-title":"Bleomycin Electrosclerotherapy (BEST) of Slow-Flow Vascular Malformations (SFVMs) in Children","volume":"60","author":"J Haehl","year":"2025","journal-title":"J Pediatr Surg"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1632","DOI":"10.1007\/s00270-025-04178-5","article-title":"Combining Reversible Electroporation and Bleomycin in Treatment of Arteriovenous Malformations","volume":"48","author":"F Obereisenbuchner","year":"2025","journal-title":"CardioVascular and Interventional Radiology"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.3390\/biomedicines13051055","article-title":"Bleomycin Electrosclerotherapy (BEST) for Slow-Flow Malformations of the Upper Aerodigestive Tract","volume":"13","author":"V Vielsmeier","year":"2025","journal-title":"Biomedicines"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2014-204575","article-title":"Bleomycin-induced skin toxicity: Is it always flagellate erythema?","volume":"2016","author":"SP Verma","year":"2016","journal-title":"BMJ Case Rep"},{"key":"ref30","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.29733","article-title":"Pharmacokinetics of bleomycin sclerotherapy in patients with vascular malformations","volume":"69","author":"JM Mack","year":"2022","journal-title":"Pediatr Blood Cancer"}],"container-title":["R\u00f6Fo - Fortschritte auf dem Gebiet der R\u00f6ntgenstrahlen und der bildgebenden Verfahren"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2783-4420.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T22:54:46Z","timestamp":1790376886000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2783-4420"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,6]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,9,25]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2783-4420","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1438-9029","1438-9010"],"issn-type":[{"value":"1438-9029","type":"print"},{"value":"1438-9010","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,6]]}}}