Tumour ablation by laser in dermatology

Abstract

The role of CO2 laser in plastic surgery and dermatology is nowadays well established. It has proved to be efficient within different contexts (haemorrhagic-infectious-necrotic ...) or on different tissues as skin, muscles and mucosae. But the role of lasers in oncologic cutaneous surgery is not as precise. The CO2 laser is to be used in a focused mode, to realize the excision of tumour, whatever its size. The advantages lie in minimized blood loss, and in permitting all types of reconstruction (suture, graft or flap). Some clinical cases of photodynamic therapy are reported, but do not appear to be conclusive. Anyhow, PDT is still under investigation and does not seem to be ready yet for routine clinical use. The principle of tissue photo-ablation with excimer of Er-YAG lasers shows some possible interest in the case of tumour treatment. But, here again, this technique has not yet proved to be for any real advantage, as far as technology is concerned. Whatever the type of laser to be used, one basic principle is to completely excise the tumour to meet the classical requirements of oncologic surgery, i.e. to be far enough from the lesion, and to get a microscopic identification of the whole specimen. We therefore think that the use of lasers in case of cutaneous tumour therapy must be considered as follows. The CO2 laser: a useful device (but not a must) which can be used as a normal knife but offering the major advantage of almost bloodless surgery. Until today, spread of metastasis has not been found to be less frequent than with conventional surgery. PDT and photo-ablation: may be of interest in the future, but at the moment: