This report  consists of a review  of the ue of lasers in the treatment of superficial  cutaneous vascular  lesions, followed  by details  of the use of two types of yellow light lasers in Australia. A Candela  pulsed  dye laser was used at the Royal Prince Alfred Hospital,  Sydney, and  a Norseld  copper  bromide laser at Flinders  Medical Centre,  Adelaide.

Yellow light lasers are a relatively  recent  approach to the treatment of port wine stains  and  other  superficial vascular  lesions.  They offer advantages over earlier  methods in having  fewer adverse effects, particularly scarring,  and often giving  more  complete  removal  of the lesion, especially  in children with light-coloured lesions.

Initial  treatment involves  checking  the response of a small  area  of the lesion (a test patch)  to the laser  radiation. For patients with  port  wine stains,  the Candela  pulsed  dye laser and  the Norseld  copper  bromide  laser gave similar results,  with  most responses being good  or excellent.

For 23 patients with  port  wine stain  whose  treatment with  the Candela  laser was completed, excellent or good  responses were obtained in 20, two had  a fair response and  one person  had  poor  results.  Incomplete treatment results  on 45 patients treated  with  the Norseld  laser suggested that that system  would  also be effective in treatment of port  wine stain.

The Candela  laser was also effective in treating a range of other  conditions. Good  or excellent  results  were obtained in the majority  of patients treated  for telangiectasia (46 of 48), spider  naevi (25 of 26), rosacea (12 of 14) and other less common  conditions (7 of 12).

Most patients at the Sydney  unit  were satisfied  with  the results  of treatment, as judged  by their responses on a seven-point scale indicating the degree  of happiness with  outcome.  On some  occasions,  the patient's perception of the final outcome varied  substantially from  that  of the operator.

Notional costs for a single  30-minute  treatment session,  excluding rental  of premises, salary-related overheads and  insurance, were estimated at $227 for the Candela  pulsed  dye laser and $110 for the Norseld  copper  bromide  laser.

On the basis of experience  at Royal Prince Alfred Hospital, the total cost of treating a port  wine stain  in an adult  with  the Candela  laser might  range  from $687 to $1,832, depending on the size of the lesion and  the number of sessions required. It was not possible  to estimate  the total cost of treating a port wine stain  with  a copper  bromide laser from  the data  available  from the Adelaide study.

Infrastructure requirements are modest  for either  type of laser if adults  are being  treated. Treatment of children  usually  requires  a general  anaesthetic which  substantially increases  the total cost.

Treatment with  currently available  lasers  is slow. Treatment of an area of 20 cm2 takes about  10 minutes with  the Candela  or the Norseld  devices.  In most cases, patients will need  to return for further treatment to achieve  maximal fading,  wit,h an interval of several  weeks  between treatment sessions.

At present, time to complete  treatment with  the Candela laser  at the hospital is further increased because  of limits to the number of clinics that can be offered.  As a result,  the waiting time for patients requiring follow-up treatment is substantially longer  than  appropriate.

With  present  technology, it is unlikely  that  any one  machine  will meet  all the requirements of a dermatology department. Ideally,  access to more  than  one laser type would  be needed  to optimise treatment for each patient.

Newer  types  of laser are becoming  available  which  will offer the promise of reducing costs of treatment. When  these  are considered for acquisition, they should  be critically  assessed  in terms  of cost, speed  of treatment, complications and  patient  outcomes.