Superpulsed CO2 Laser Treatment of Basal Cell Carcinoma With Intraoperatory Histopathologic and Cytologic Examination

Abstract

background. CO 2 laser is currently one of the most versatile and useful laser devices in dermatologic practice in the fields of both cosmetology and oncology. The CO 2 laser in a superpulsed mode enables the operator to effect precise and adequate vaporization of the affected area, with the possibility to appreciate visually the depth achieved, and, when necessary, to perform histologic and cytologic examination of the surrounding skin. objective. To show superpulsed CO 2 laser treatment of basal cell carcinoma. methods. One hundred forty patients presenting single, multiple, superficial, or nodular basal cell carcinoma (BCC) have been treated with the superpulsed CO 2 laser. Before the laser treatment the lesion was subjected to cytologic examination by scraping; this examination was then repeated when the papillary dermis was clinically detectable, and again when the operator considered the BCC completely vaporized. In selected sub-jects, histopathologic examination was done three times (biopsies were obtained at the same time as the samples for the cytologic examination). results. Recovery time was fast, with good healing outcomes. After 3 years follow-up no recurrences were seen. The cytologic and histopathologic examinations showed BCC in the specimens obtained prior to and during laser therapy, but not in those obtained after laser therapy. conclusion. This technique causes minimal thermal cellular damage and no severe morphologic cellular alterations. Thus it permits an intraoperatory cytologic and histopathologic examination. Finally, this technique enables the operator to recognize the different skin levels removed by vaporization and to stop the vaporization as soon as unaffected dermis has been reached, as shown by intraoperatory cytologic and histopathologic examination.

Basal Cell Carcinoma. Treatment with Carbon Dioxide Laser Vaporization

“…In With ablative lasers as carbon dioxide laser (Adams and Price 1979, Wheeland et al 1987, Fairhurst et al 1992, Grobbelaar et al 1997, Krunic et al 1998, Humpreys et al 1998, Horlock et al 2000, Nouri et al 2002, Campolmi et al 2002, Robinson et al 2003 and erbium:YAG laser (Smuckler et al 2008), the angiogenic component being a guide to the surgeon that indicates the elimination of the tumour, the lesion can be vaporized as deep as possible with the increase of the passes number. The ability to vaporize of carbon dioxide laser is higher than erbium:YAG laser and the majority of studies concerning the treatment of BCC with ablative lasers was performed with CO2 laser.…”

“…Carbon dioxide laser treatment of BCC have been largely described several years ago but few studies have been performed and they showed very different results (Adams and Price 1979, Wheeland et al 1987, Humpreys et al 1998, Horlock et al 2000, Campolmi et al 2002. Adams and Price (1979) reported the use of the carbon dioxide laser to treat BCC in 1979 using a continuous output laser.…”

“…Several treatment options for basal cell carcinoma have been described including surgical excision (Walker et al 2006), curettage (Barlow et al 2006) and cautery (Spiller et al 1984), cryotherapy (Mallon et al 1996, Kokoszka 2003, radiotherapy (AlOthman 2001), photodynamic therapy (Star et al 2006, Chapas et al 2006, Brathen et al 2007, micrographic surgery (Bieley et al 1992, Rowe et al 1989), ablative laser (Goldman and Wilson 1964, MacGuff 1966, Goldman et al 1968, Adams and Price 1979, Wheeland et al 1987, Fairhurst et al 1992, Grobbelaar et al 1997, Krunic et al 1998, Humpreys et al 1998, Horlock et al 2000, Nouri et al 2002, Campolmi et al 2002, Robinson et al 2003, and Smuckler et al 2008, other laser systems (El-Tonsy et al 2004, Moskalik et al 2009, Allison et al 2003, Campolmi et al 2008, Shah et al 2009, Konnikov et al 2011, Ibrahimi et al 2011, topical treatment with 5-fluorouracil and immunomodulators, such as imiquimod (Kagy andAmonette 2000, Schulze et al 2005) and intralesional agents as interferon (Greenway et al 1986).…”

Ablatif Lazerler

“…Özellikle antikoagülan kullanan hastalarda ve çok sayıda lezyonu olup cerrahiye uygun olmayan hastalarda diğer tedavi alternatiflerine bir üstünlük sağlar. Ayrıca iyileşme sürecinin daha kısa olması ve daha kozmetik sonuçlar sağlaması diğer avantajlarıdır.33 Histopatolojik incelemenin yapılamaması ve ilave ekipman gerektirmeleri ise dezavantajlarıdır 34 . Humphreys ve arkadaşlarının açık prospektif bir analiz çalışmasında35; 30 yüzeyel neoplazmada (17 Bazal hücreli karsinom ve 13 skuamöz hücreli karsinoma insitu) CO2 lazerin etkinliğini incelediler.…”

“…Skuamöz hücreli karsinomlarda sıklıkla bulunan azalmış su miktarı ve hiperkeratoz, Bazal hücreli karsinomlara kıyasla tedaviye yanıtın daha az olasında önemli gibi gözükmektedir ve Skuamöz hücreli karsinomların tedavisinde tek başına CO2 lazer tedavisini pek tavsiye etmemektedirler. Takip eden çalışmalar, süperfisyal ve nodüler bazal hücreli karsinomların ablasyonunda superpulse CO2 lazerin etkinliğini desteklemişlerdir 34 . Yüzeyel veya nodüler Bazal hücreli karsinomu olan 140 hasta çevre dokuda 2 mm sınır ile derin dermise kadar CO2 lazer ile tedavi edildiler.…”