Successful Treatment of Low-Flow Vascular Malformation in the Lip Using Intralesional Bleomycin: A Case Report

Vascular malformations (VMs) are congenital abnormalities of blood or lymphatic vessels, present at birth and growing proportionally with the individual. They are classified into types such as capillary, venous, lymphatic, and arteriovenous malformation (AVMs). Symptoms include discoloration, swelling, pain, or functional impairment, depending on the type and location. Diagnosis involves imaging like ultrasound, MRI, or angiography, and treatment options include sclerotherapy, laser therapy, embolization, or surgery for symptomatic cases. It is a class of vascular anomalies, known as VMs are benign lesions that arise from aberrant vascular tissue and can result from either lymphatic proliferation or angiovascular dysregulation. High-flow VMs, such as AVMs, involve direct connections between arteries and veins. AVMs can be congenital, presenting at birth. They are typically persistent and progressive, with the potential to cause significant blood loss, which can be life-threatening. Several treatment modalities are available, including surgical excision, electrocautery, LASER therapy, cryotherapy, radiotherapy, and the use of locally injected agents. Among these, sclerosing agents are particularly advantageous due to their affordability, availability, and high efficacy. Commonly used sclerosing agents include ethanol, sodium morrhuate, sodium tetradecyl sulfate (STS), boiling contrast media, and bleomycin. This case report describes a VM with low-flow characteristics located at the commissure of the lip, which was successfully treated with intralesional bleomycin injections. The aim of this case report is to document the successful management of a low-flow VM at the lip commissure using intralesional bleomycin injections. It highlights the efficacy and safety of this minimally invasive treatment in achieving favorable cosmetic and functional outcomes. The study also seeks to contribute to the growing evidence supporting sclerotherapy as a reliable alternative to surgical intervention.