39 year-old female with several large compound nevi present on the left chin and the left cheek. The patient desires removal for cosmetic purposes.
LASER OF CHOICE: CARBON DIOXIDE
The CO2 laser is able to photovaporize pigmented lesions of the skin. Using a defocused "paint brush" technique one can remove layer by layer of these nevi until the upper dermis is present and the base of the nevus is removed. The lesion is photovaporized and smoke evacuation of the plume is very important. The CO2 laser is selectively absorbed by the water in the cells of the nevus and as this water is converted to steam the cells explode, producing the laser plume. Adjacent skin is not affected.
Immediately after treatment
One year after
Slight scar but satisfactory results.
It is very important to biopsy any lesion, especially a pigmented lesion, which is photo destroyed by the laser. One would not want to photovaporize a pigmented basal cell carcinoma or melanoma inadvertently. Therefore, it is recommended that a small incisional biopsy be removed before destroying any pigmented lesion. It is important not to completely penetrate through the dermis as this would produce a full-thickness injury and subsequent hypertrophic scar.
The patient is instructed to apply aloe vera ointment or antibiotic ointment and is allowed to shower normally. No bandage is required.