Minimizing Skin Cancer Surgical Scars Using Ablative Fractional Er:Yag Laser Treatment

October 2013 | Volume 12 | Issue 10 | Case Reports | 1171 | Copyright © October 2013


Joel L. Cohen MD

AboutSkin Dermatology and DermSurgery, Englewood, CO

Abstract
BACKGROUND and OBJECTIVE: Scars from skin cancer surgery on the face can be quite prominent and not easily obscured by makeup. This report evaluates the use of an ablative fractional Er:YAG laser device for minimizing or blending scar lines in two patients who underwent repair of skin cancer defects on the face.
METHODS: Two patients underwent surgery to remove facial skin cancer tumors. The resulting scars after reconstruction of these skin cancer defects on the left cheek (Case 1) and right cheek (Case 2) each received 3 treatments with a fractional ablative laser device (ProFractional-XC, Sciton, Inc., Palo Alto, CA). Treatments were spaced about 1 month apart. Topical anesthetic cream applied 1 hour before treatment minimized patient discomfort during the procedure. Treatment depths ranged from 150 to 200 microns, 2 passes were performed, and coverage per pass was typically 22% and then 11% in the coagulation mode. Results were evaluated by digital photography before the initial treatment, approximately 4-5 weeks after each of the 3 treatments, and at approximately 7 months after the surgical procedures.
RESULTS: The fractional Er:YAG laser device significantly improved postsurgical scar lines in each patient without significant adverse effects. Prior to the laser sessions, these scars demonstrated hypopigmentation, hyperpigmentation, neovascularization, or diminished pore structures compared to the surrounding skin. These pigmentary, vascular or textural issues were all significantly improved by the fractional ablative Er:YAG laser.
CONCLUSION: The ablative fractional laser device of the present report safely minimizes and improves facial scars demonstrating not only textural alterations but also some pigmentary and vascular changes after reconstruction of skin cancer defects.

J Drugs Dermatol. 2013;12(10):1171-1173.

INTRODUCTION

A short-pulsed Er:YAG laser emits 2940-nm energy which is absorbed 12 to 18 times more efficiently by superficial aqueous tissue than the 10,600-nm energy of the CO2 laser.1 Tissue ablation with Er:YAG has been found to be more precise and demonstrates reduced residual thermal damage, resulting in shorter recovery times and a more favorable side effect profile than the CO2 laser.2,3 The dual-mode Er:YAG laser produces both ablative and coagulative pulses and produces greater collagen contraction, deeper tissue vaporization, and improved hemostasis.4
The concept of fractional photothermolysis was introduced in 2004.5 The use of this modality in the treatment of scars has been reported.6-10
This current report demonstrates the utility of a fractional ablative Er:YAG laser device to treat facial scars resulting from surgery to remove skin cancer.

METHODS

Two patients underwent surgical excisions (Case 1 standard excision, Case 2 Mohs micrographic surgery) to remove facial skin cancer tumors. When the wounds were completely healed and 2-3 months had passed, the resulting surgical scars each received 3 treatments with a fractional ablative Er:YAG laser device (Profractional-XC, Sciton, Inc.). Surgical scar lines displayed telangiectasia, hypo- or hyper-pigmentation, or isolated fibrotic lines within the context of adjacent normal skin and the associated normal skin pore structures. Topical anesthetic cream applied one hour before treatment minimized patient discomfort during the procedure. Treatment depths ranged from 150 to 200 microns,with two passes performed at coverage of 22% and then 11% in the coagulation mode. Treatments were spaced about 4-5 weeks apart and scheduled according to patient availability and interest in pursuing laser treatments. Results were evaluated by digital photography before the initial laser session, approximately 4-5 weeks after each of the 3 laser treatments, and at approximately 7 months after the surgeries. Each patient provided signed informed consent to treatment and use of their photographs for scientific, teaching, or marketing purposes.

CASES

Case 1

A 48-year-old female presenting with a melanoma in-situ on her left superior cheek underwent surgical excision to remove
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