Histological findings after argon plasma coagulation: an ex-vivo study revealing a possible role in superficial ablative treatment of the skin

Abstract

Argon plasma coagulation (APC) is an electrosurgical technique which can be used to ablate skin lesions with limited invasion depth into dermal tissue. Hence, APC might be well suited for the removal of epithelial tumours. However, there are no data on the effects of APC on human skin tissue. Thus, the aim of this study was to determine the extent of epidermal and dermal damage after APC of human skin. We performed APC ex-vivo on 91 freshly resected human skin samples, which were obtained after reconstructive surgical closures in actinically damaged areas. Tissue effects were evaluated histologically and compared across different power settings. Using 15, 30, and 45 W, median (interquartile range; IQR) coagulation depths were 110.0 µm (91.7-130.0), 113.3 µm (85.8-135.0), and 130.0 µm (100.0-153.3.0), respectively. Median (IQR) thickness of necrosis zone was 30.0 µm (23.3-40.0) at 15 W, 26.7 µm (20.0-41.6) at 30 W, and 43.3 µm (30.8-57.5) at 45 W. The Kruskal-Wallis test showed significant differences between 15 and 30 W versus 45 W for coagulation depth (P = 0.0414), necrosis zone (P = 0.0017), and necrosis according to overlaying epidermal thickness (P = 0.0467). In summary, APC is a simple and controllable electrosurgical technique to remove epidermal tissue with limited penetration to the dermis. Thus, APC is particularly suited for the ablation of epithelial skin lesions and, therefore, may serve as possible treatment approach for intraepithelial neoplasms such as actinic keratosis.

Argon plasma coagulation of actinic keratoses imaged by optical coherence tomography: An in vivo study indicating a possible lesion‐directed treatment

“…It is because this energy level should ideally ablate the entire epidermis while causing as less damage to dermal layers as possible. Our ex vivo study on different power settings revealed this energy level to be sufficient regarding epidermal removal while saving dermal tissue . In addition, the clinical impression of a complete wipe off of the entire treated epidermis supported the assumption of 15 W to be sufficient.…”

“…The ERBE ICC 350D/APC 300 (Erbe Elektromedizin, Tuebingen, Germany) APC system with a flow rate of 2.0 L/min was used. A power setting of 15 W and the spray application mode were chosen as described elsewhere . APC was carried out by the same user (FB) and always with an application probe with spatula‐shaped tip.…”

“…We showed that APC leads to a well controllable ablation of superficial skin layers while saving dermal structures. Hence, APC might be a useful lesion‐directed approach for distinct AKs .…”

Argon Plasma Coagulation as Treatment for Anal Condylomas: A Narrative Review

“…25 Deep lesions, however, are associated with a higher risk of postoperative infection and pain. 8 A constant ablation depth poses an advantage when compared with cryotherapy and laser treatment, 27 and, given the coagulation depth, this technique seems suitable to treat intraepithelial neoplasms. 27 Argon plasma coagulation is also an effective technique in cases of lesion recurrence, which is common when other available treatments are used.…”

“…8 A constant ablation depth poses an advantage when compared with cryotherapy and laser treatment, 27 and, given the coagulation depth, this technique seems suitable to treat intraepithelial neoplasms. 27 Argon plasma coagulation is also an effective technique in cases of lesion recurrence, which is common when other available treatments are used. 6,18,28 In the studies included here, recurrences First report Gut 1999 (same sample).…”