Laser Surgery As A Treatment For Sarcoids In Horses

What Are Sarcoids?
Equine sarcoids are the most common skin tumour in the horse, accounting for 40% of all equine cancers. They are locally invasive tumours which are variable in appearance, location and rate of growth. Sarcoids are caused by Bovine Papilloma Virus, which may be spread by flies. Not all horses that are exposed to the virus develop sarcoids but, it appears that some horses are more susceptible than others. This also explains why horses that have sarcoids will stay susceptible and are more likely to grow additional sarcoids. People are often concerned about whether sarcoids are contagious because of the viral cause. No proof has yet been found that shows horse to horse contact can cause horses to develop sarcoids.
Sarcoids mainly occur around the head and in the groin and axilla area.
They seldom affect a horse’s usefulness, unless they are in a position likely to be abraded by tack. They do not usually resolve on their own and most horses develop multiple sarcoids.

Types of Sarcoids
Nodular sarcoids–are firm spherical nodules found under normal looking skin. They can be variable in size and can become ulcerated.
Verrucous sarcoids–are slow growing, flat scaly tumours that look like warts. They can also look like ringworm or scars.
Fibroblastic sarcoids–are fleshy lumps which often ulcerate, because they grow rapidly. They often occur in clusters and have an irregular shape.
Occult sarcoids–are flat hairless patches that occur mostly around the eyes, mouth and neck.
Malignant sarcoids –highly aggressive and these spread via lymphatic vessels, which results in lines of sarcoids spreading from the original sarcoid.

Diagnosis
Sarcoids can, in some occasions, be confused with other tumours. Although a biopsy can give more information into what kind of tumour your horse has, taking a small sample of a sarcoid can cause the lump to start growing rapidly. Because sarcoids are the most likely diagnosis for these lumps, your vet will most likely suggest complete removal and possible sending the tissue off to a lab for histopathology, which can determine if the lump was in fact a sarcoid.

Treatment
Treatment or removal of sarcoids are not always necessary but, when treatment is required it can prove difficult and possibly expensive. Sarcoids can regrow after treatment and no treatment as of yet is 100 % successful. Success rates vary between types of treatment. It is important to note that every treatment failure , reduces the success rates of future attempts.

-Ligation; where the sarcoid blood supply is cut off, causing it to shrink and drop off over time. Recurrence rates are more then 50%.
-Creams; there are various types, some more irritant to the skin than others and some have to be applied by your vet. They have a success rate of 40-60%.
-Injections; A chemotherapy drug injected into nodular and fibroblastic sarcoids causing the lesions to regress but can cause local swelling and sometimes injections need repeating.
-Radiation therapy; Iridium wires are inserted into a sarcoid to destroy it. It is the most effective treatment method but is very expensive and not widely available
-Laser Removal; is a surgical instrument that cuts into and vaporizes soft tissue with minimal bleeding. The wound that the horse is left with heals very well on its own. This treatment has one of the highest success rates with 80-90 % of horses not re-growing the sarcoid that was treated and, 70% of horses did not develop new sarcoids.
On the rare occasion that sarcoids regress on their own, these horses seem to develop immunity and do not develop further sarcoids. Please talk to your vet for more information on treatment options.

Sarcoids

Equine sarcoids are spontaneous, locally invasive tumours of the skin of horses, mules, and donkeys and are the most common equine neoplasm representing over half of all equine tumours. They are variable in appearance, location and rate of growth and although they seldom affect a horse’s usefulness (unless they are in a position likely to be abraded by tack) they are unsightly and may cause considerable discomfort to the horse.

They can occur anywhere on an animal’s body although areas exposed to trauma or skin damage seem more commonly affected, they may proliferate in size and number and may develop at other sites. Treatment is not always necessary but where required it can prove difficult and expensive and re-growth may occur after treatment. They are thought to be caused by the Bovine Papilloma Virus which may be spread by flies (the face fly Musca autumnalis) which act as vectors spreading the infectious agent between individuals.

Sarcoids are classified according to their appearance:

NODULAR SARCOIDS are firm spherical nodules found under normal looking skin, they can be variable in size and number and some can ulcerate and become fibroblastic.

VERRUCOUS SARCOIDS are slow growing wart like proliferations of the skin which are seen particularly on the face, groin and body.

FIBROBLASTIC SARCOIDS are fleshy proliferative growths which often ulcerate and are locally invasive and are seen on the eyelid, lower limbs, groin, coronet, and areas of trauma.

FLAT (OCCULT) SARCOIDS are single or multiple patches of hair loss which may contain nodules and often become locally aggressive, they are seen particularly around the mouth, eyes and neck.

MIXED SARCOIDS are transitional between verrucous and fibroblastic and become progressively more aggressive as more fibroblastic transformation takes place.

MALEVOLENT SARCOIDS are multiple and invasive tumours which spread along lymphatic vessels and lymph nodes, they are frequently the result of repeated trauma e.g. surgery to other types of sarcoid but not all malevolent sarcoids develop as a result of this

Treatment is always more effective if implicated as soon as possible after the sarcoid appears.

Treatments available include:

Application of a band or lamb ring to nodular sarcoids cuts off the blood supply causing them to shrink and drop off over a period of time. However there is a risk that the sarcoid will recur after treatment, occasionally in a more aggressive form as it is not always possible to get the root.

Application of creams –

Antiviral creams (such as aciclovir and imiquimod) have been used to good effect on some occult sarcoids. They often need application over a prolonged period of time but the benefit is they are unlikely to make the sarcoid worse and are cheap so often worthwhile trying as a primary treatment.

Bloodroot ointment can be used on small occult/verrucous sarcoids to good effect. It does cause some local irritation and swelling but this is transient, the cream can be applied by the owner.

Cytotoxic creams containing heavy metals and 5 fluorouracil are prepared by Professor Derek Knottenbelt and his team (formerly of Liverpool University). They are very effective at causing sarcoids to die and fall off but can cause quite severe swelling and damage to surrounding skin. It must be applied by a veterinary surgeon under strict routine and management conditions.

Injection of chemotherapeutic chemicals

Mitomycin C is an anti cancer drug which can be effectively injected into nodular and fibroblastic sarcoids by the vet causing them to regress. Again local swelling is to be expected and sometimes injections need repeating after a couple of months.

Radioactive implants

Iridium wires are inserted into the sarcoid to destroy it. As the treatment is radioactive the treatment can only be carried out at certain premises under strict regulations so is very costly but can be the only option for some sarcoids around the eyes.

Sarcoids can be a serious problem & take a variety of forms however with the right treatment approach they can be managed before they become too extensive.

There are many anecdotal reports of other treatments from applying toothpaste to piercing a black slug with the thorn from a hawthorn bush and squeezing the juices onto the sarcoid! However we strongly advise owners to stick with treatments from veterinary surgeons which have been scientifically proven to work rather than waste time and subject the horse to further distress with treatments that may do more harm than good.