ABSTRACT
Most Other Modalities 146
6.1.1. Trichoepitheliomas 147
6.1.2. Adenoma Sebaceum 147
6.1.3. Common Warts 148
6.1.4. Condyloma Acuminata 150
6.1.5. Nail Matrixectomy 150
6.1.6. Earlobe Keloids 151
6.1.7. Larger Keloids and Nonearlobe Keloids 151
6.2. Acne Keloidalis Nuchae 152
6.2.1. Pyogenic Granuloma 152
6.2.2. Actinic Cheilitis 153
6.2.3. Sebaceous Hyperplasia 154
6.2.4. Epidermal Nevi 155
6.2.5. Syringoma 156
6.2.6. Xanthelasma 156
7. Lesions that Might Be Treated Equally Well with Other Modalities 157
7.1. Seborrheic Keratoses 157
7.2. Dermatosis Papulosis Nigra 157
7.3. Neurofibromas 157
7.4. Steatocystomas 158
7.5. Pearly Penile Papules 158
7.6. Basal Cell Carcinoma 159
7.7. Bowen’s Disease 159
7.8. Hidradenitis Suppurativa 159
7.9. Scar Revisions 159
7.10. Chondrodermatitis Nodularis Helicus 160
7.11. Lymphangioma Circumscriptum 160
7.12. Nevus Sebaceous 160
7.13. Hydrocystoma 160
7.14. Histiocytoma or Xanthoma Disseminatum 160
7.15. Hailey-Hailey and Darier’s Disease 161
7.16. Kaposi’s Sarcoma 161
7.17. Tattoos 161
7.18. Disseminated Superficial Actinic Porokeratosis 162
7.19. Actinic Keratosis 162
8. Laser Sterilization 162
9. Technique Pearls 162
9.1. CW Vaporization 162
9.2. Cutting 163
10. Laser Safety Issues Specific to the CO2 Laser 163
11. New Developments 164
12. Pre-and Postoperative Considerations 164
12.1. Preoperative Considerations 164
12.1.1. Relative Contraindications 164
12.1.2. Preoperative Regimen 165
12.1.3. Postoperative Care 165
13. Conclusions 165
References 166
Appendix I: Sample Operative Note 176
Appendix II: Consent Form 177
Appendix III: Sample Postoperative Instructions 178
Appendix IV: Patient Information Handout 178
1. BACKGROUND
The CO2 laser was one of the first lasers to be used surgically. Since its invention by Patel
in 1964, the laser’s strength is linked to its high absorption by water at 10.6 mm. The first published studies using the CO2 laser emphasized the device as a cutting tool with
improved hemostatic capabilities over scalpel surgery, and typically the laser was used
with a tightly focused beam (1). Subsequently, especially in dermatology, the laser has
been used more as a defocused vaporizing or controlled heating tool. With the CO2 laser, one can simultaneously hold a coagulator, scalpel, and vaporizer, depending on
the power density (2).