Background. Cheilitis is a precancerous skin lesion most often affecting the lower lip. We describe a technique in which this disorder can be treated using Er:YAG laser vaporization. The Er:YAG laser wavelength at 2940 nm lies in a very strong water absorption peak; tissue interaction results mainly in vaporization with minimal heat conduction to adjacent tissue. Objective. To evaluate the efficacy and outcome of a new modality in the treatment of actinic cheilitis with the Er:YAG laser. Methods. Between 2002 and 2005, 12 patients with actinic cheilitis were treated at our institute with the Er:YAG laser. All patients were cured with no recurrence to date, and none suffered postoperative complications. Results: Patients were men and women aged between 37 and 71 years. The healing duration varied from 7 to 30 days (mean 22.33±6.91 days) and the follow‐up ranged from 8 months to 3 years (mean 23.16±9.48 months). No recurrences were detected in our study. Conclusion. Using the Er:YAG laser provides accurate tissue ablation, giving a very satisfactory cosmetic result, with a short healing period, no lip deformity and no sensation loss.
A novel spectral image-analysis system was used for tumor fluorescence and reflectance imaging in an animal model and in patients. Transcutaneous fluorescence imaging was carried out on Balb/c mice bearing subcutaneous C26 colon carcinoma after intraperitoneal (i.p.) administration of 5-aminolevulinic acid (ALA), a metabolic precursor of protoporphyrin-IX (PP), and of a novel photosensitizer tetrahydroporphyrin (THP). Tumors were clearly observable by fluorescence detection using green light excitation. Tumor versus normal tissue uptake of the photosensitizing agents was determined by monitoring fluorescence intensity. Maximal PP accumulation in tumor was observed 3 h after i.p. injection of ALA, whereas THP showed selective accumulation in tumor 24 h after administration. Reflectance spectroscopy was employed to study pigmented human skin lesions (nevus, pigmented BCC and pigmented melanoma). In the near-infrared region (800-880 nm) pigmented BCC and melanoma exhibited a differently shaped reflectance spectrum compared to normal skin and nevus. Spatially and spectrally resolved imaging, in combination with mathematical algorithms (such as normalization, spectral similarity mapping and division) allowed unambiguous detection of malignancies. Optical biopsy results from a total of 51 patients showed 45 benign nevi, 3 pigmented BCC and 3 malignant melanomas, as confirmed by histology.
Abstract. Benign nevi can be removed by a variety of procedures including surgical excision, electrocautery, slicing off the protruding portion by a shave biopsy, cryotherapy, dermabrasion, etc. Except in the case of complete excision, these procedures may often be followed by recurrence. We describe a congenital nevus that was incompletely removed by CO 2 laser therapy. When the lesion recurred, it had clinical as well as histologic features in common with malignant melanoma, although it was completely benign.
An ingrowing toenail is an excessive lateral nail growth into the nail fold. It acts as a foreign body and exerts a local pressure sore-like effect, which may result in inflammation and granulation. Several treatment modalities exist, including chemical ablation and different surgical procedures. Here we describe and compare a simple and effective method of partial matricectomy using the CO2 laser (group A) versus a similar method with the addition of lateral nail fold vaporization (group B).Outcome evaluation of a modified laser treatment modality for ingrowing toenails and determination of the role of lateral fold vaporization in reducing the recurrence of symptoms.Forty patients (mean age 32.45 years) were treated with CO2 laser ablation of toenails between 1999 and 2005 by four physicians. One physician implemented a method that includes lateral nail fold vaporization and resection of the nail segment with its nail bed from 1999 to 2005. Three physicians implemented a similar technique but without lateral fold vaporization between 1999 and 2003, and added lateral fold vaporization to the performed procedure starting in 2004.The recurrence rate was 37.5% in group A and 6.2% in group B. The overall average disease-free follow-up period was 42.2 months.The use of CO2 laser in the treatment of ingrowing toenails offers an effective modality. We demonstrate the importance of lateral fold vaporization with the CO2 laser both in improving efficacy and in decreasing recurrence rates over a long follow-up period.
Photodynamic therapy (PDT) with topical application of 5-aminolevulinic acid (ALA) is a new and effective modality for treatment of superficial basal and squamous cell carcinomas.We present the kinetics of ALA-induced protoporphyrin IX (PP) accumulation and the results of ALA PDT treatment on two patients with different stages (stage I and stage III) of mycosis fungoides (MF)-type cutaneous T-cell lymphoma (CTCL).ALA-Decoderm cream was applied to the lesions for 16 hours. Spectrofluorescence measurements of PP accumulation were carried out before, during, and 1 hour after photoirradiation (580-720 nm) using the VersaLight system.Different patterns of PP fluorescence kinetics were observed in patients with early and advanced stages of the disease. During photoirradiation the intensity of fluorescence decreased depending on the lesion thickness. One hour after the photoirradiation procedure no PP fluorescence was observed in the stage I MF lesion, while in the thick stage III MF lesions, PP fluorescence reappeared; after an additional 10-15 minutes of irradiation PP fluorescence disappeared. Complete response with excellent cosmetic results was observed in the stage I lesion after a single irradiation with a light dose of 170 J/cm2; in five stage III lesions, complete response was achieved after fractionated irradiation with a total light dose of 380 J/cm2 (follow-up at 27 and 24 months, respectively).The results showed a high response of both stage I and stage III MF lesions to ALA PDT. This modality appears to be very effective and can be used successfully for MF treatment.
The results of photodynamic therapy (PDT) in 48 patients bearing basal cell carcinoma (BCC) and 7 patients with squamous cell carcinoma (SCC) of the skin are described. Five- aminolevulinic acid (5-ALA) was applied topically in two formulations. The first formulation contained 20% of 5-ALA in a base cream, and the second formulation (5-ALA composite cream), contained an additional 2% of dimethylsulfoxide (DMSO) and 2% of edetic acid disodium salt (EDTA). The creams were left on the skin for 2 - 5 hours. Production of protoporphyrin (PP) was measured in situ by a laser-induced fluorescence (LIF) method. The results of fluorescence measurement clearly indicate that PP accumulation in tumors induced by the 5-ALA composite cream was markedly higher than that induced by the 5-ALA cream. The tumors were light-irradiated (600 - 720 nm) after 4 - 5 hours of cream applications, using the light delivery system Versa-Light by a light dose of 100 J/cm2. The clinically superficial BCC tumors were highly responsive to PDT; the overall result in BCC patients was an 85.4% complete response. Histological examination showed an initial edematous reaction, followed by necrosis and complete disappearance of the tumor. The superficial SCC tumors showed a 100% complete response after PDT. The ulcerated nodular SCC showed partial responses.
