Use of Carbon Dioxide Laser to Treat Lentigo Maligna and Malignant Melanoma In Situ, Lentigo Maligna Type

Abstract

Archives of Facial Plastic SurgeryVol. 14, No. 6 Free AccessUse of Carbon Dioxide Laser to Treat Lentigo Maligna and Malignant Melanoma In Situ, Lentigo Maligna TypeMichael McLeod, Katlein Franca, Katherine Ferris, and Keyvan NouriMichael McLeodSearch for more papers by this author, Katlein FrancaSearch for more papers by this author, Katherine FerrisSearch for more papers by this author, and Keyvan NouriCorrespondence: Dr Nouri, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 12th Ave NW, Ste 2175, Miami, FL 33136 (E-mail Address: knouri@med.miami.edu).Search for more papers by this authorPublished Online:1 Nov 2012AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail We read with great interest the recent article published by Lee et al titled “Carbon Dioxide Laser Treatment for Lentigo Maligna: A Restrospective Review Comparing 3 Different Treatment Modalities.”1While the carbon dioxide ablative laser may offer some usefulness as a third-line treatment, the nature of its emitted light has stark limitations. Most notably, the 10 600-nm wavelength is not actively absorbed by melanocytes; instead, the laser targets water as a chromophore. In addition, the 10 600-nm wavelength may not penetrate deep enough to destroy the atypical melanocytes extending down the periadnexal structures, using reasonable fluences.2,3 Future studies may wish to explore a laser wavelength that is more actively absorbed by melanocytes, such as using indocyanine green as a photosensitizer followed by treatment with the titanium sapphire laser.4,5An important distinction needs to be made between lentigo maligna and malignant melanoma in situ, lentigo maligna type. These 2 lesions exhibit histologic nuances that likely result in differences in their biological behavior.6,7 Lentigo maligna is histologically characterized by atypical melanocytic hyperplasia along the dermoepidermal junction, whereas malignant melanoma in situ, lentigo maligna type, exhibits atypical melanocytic hyperplasia along the dermoepidermal junction along with confluence and nesting of the melanocytes at higher layers in the epidermis (ie, above the dermoepidermal junction). This histologic distinction is important because malignant melanoma in situ, lentigo maligna type, likely progresses to lentigo maligna melanoma much more quickly than the often quoted rates of 4.7% if diagnosed by age 45 years and 2.2% when diagnosed by age 65 years.4,8,9Thus, if the carbon dioxide laser is used to treat lentigo maligna, it should be used only if other modalities are not applicable and if the histologic characteristics are consistent with lentigo maligna and not malignant melanoma in situ, lentigo maligna type.Financial Disclosure: None reported.REFERENCESLee H, Sowerby LJ, Temple CL, Yu E, Moore CC. Carbon dioxide laser treatment for lentigo maligna: a retrospective review comparing 3 different treatment modalities.. Arch Facial Plast Surg. 2011;13(6):398–403 Abstract, Google ScholarMadan V, August PJ. Lentigo maligna: outcomes of treatment with Q-switched Nd:YAG and alexandrite lasers.. Dermatol Surg. 2009;35(4):607–612 19309345 Google ScholarLee PK, Rosenberg CN, Tsao H, Sober AJ. Failure of Q-switched ruby laser to eradicate atypical-appearing solar lentigo: report of two cases.. J Am Acad Dermatol. 1998;38(2, pt 2):314–317 9486705 Google ScholarMcLeod M, Choudhary S, Giannakakis G, Nouri K. Surgical treatments for lentigo maligna: a review.. Dermatol Surg. 2011; 21631635 Google ScholarMamoon AM, Gamal-Eldeen AM, Ruppel ME, Smith RJ, Tsang T, Miller LM. In vitro efficiency and mechanistic role of indocyanine green as photodynamic therapy agent for human melanoma.. Photodiagnosis Photodyn Ther. 2009;6(2):105–116 19683211 Google ScholarTannous ZS, Lerner LH, Duncan LM, Mihm MCJr, Flotte TJ. Progression to invasive melanoma from malignant melanoma in situ, lentigo maligna type.. Hum Pathol. 2000;31(6):705–708 10872664 Google ScholarTannous ZS, Mihm MC, Flotte TJ, González S. In vivo examination of lentigo maligna and malignant melanoma in situ, lentigo maligna type by near-infrared reflectance confocal microscopy: comparison of in vivo confocal images with histologic sections.. J Am Acad Dermatol. 2002;46(2):260–263 11807439 Google ScholarWeinstock MA, Sober AJ. The risk of progression of lentigo maligna to lentigo maligna melanoma.. Br J Dermatol. 1987;116(3):303–310 3567069 Google ScholarDavis J, Pack GT, Higgins GK. Melanotic freckle of Hutchinson.. Am J Surg. 1967;113(4):457–463 6023013 Google ScholarFiguresReferencesRelatedDetails Volume 14Issue 6Nov 2012 InformationCopyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Michael McLeod, Katlein Franca, Katherine Ferris, and Keyvan Nouri.Use of Carbon Dioxide Laser to Treat Lentigo Maligna and Malignant Melanoma In Situ, Lentigo Maligna Type.Archives of Facial Plastic Surgery.Nov 2012.462-462.http://doi.org/10.1001/archfaci.2012.874Published in Volume: 14 Issue 6: November 1, 2012PDF download