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).