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Recent Monte Carlo computations in realistic port wine stain (PWS) models containing numerous uniformly distributed vessels suggest equal depth of vascular injury at wavelengths of 577 and 585 nm. This finding contradicts clinical experience and previous theory. From a skin model containing normal and PWS vessels in separate dermal layers, we estimate analytically the average volumetric heat production in the deepest targeted PWS vessel. The fluence rate distribution is approximated by Beer's law, which depends upon the tissue's effective attenuation coefficient, and includes a homogeneous fractional volumetric blood concentration corrected for finite-size blood vessels. The model predicts 585-587 nm wavelengths are optimal in adult PWSs containing at least one layer of small-radius blood vessels. In superficial PWSs, typically in young children with small-radius vessels, 577-580 nm wavelengths are optimal. Wavelength-independent results similar to those from Monte Carlo models are valid in single-layered PWSs of large-radius vessels. In conclusion, the volumetric heat production in the deepest targeted PWS blood vessel can be maximized on an individual patient basis. However, absorption of 585-587 nm wavelengths is sufficiently high in superficial lesions, so we hypothesize that these wavelengths may be considered adequate for the treatment of any PWS.

Using the Monte Carlo method, we have calculated the distribution of absorbed light in skin during the laser treatment of port-wine stains. Our model includes the effect that the blood capillaries and epidermis have on the propagation of light through skin. It is more complete than those used by previous workers. In this paper, we change the number of scattering dimensions, the spot diameter, and the capillary separation and diameter, and we use the wavelengths 577 nm and 585 nm. One-dimensional scattering calculations are misleading but two-dimensional results suffice for large spot diameters. The model shows that changing the position or diameter of the capillaries has a larger effect on the distribution of absorbed light in the skin than changing the wavelength of the laser beam from 577 nm to 585 nm. Changing the wavelength does increase absorption in the deeper capillaries, but this is not significant. From our results, we discuss the optimal treatment of port-wine stains.