Presidential Greeting - American Society for Laser Medicine and ...

28 American Society for Laser Medicine and Surgery Abstracts
Results: Independent evaluator assessment demonstrated
statistically significant improvement in overall appearance,
pigmented lesions, dyschromia, textural irregularities and fine
lines of all treated body areas. Near-optimal results were reached
after 8 weeks of treatment and effects were still apparent 1 month
and 3 months following the final treatment. Subject perception of
treatment outcomes was positive. The treatment was welltolerated,
with a very low incidence of side effects and with limited
downtime. Histological results revealed that thermal damage,
epidermal regeneration, pigment removal and neocollagenesis
were consistently observed and were similar to treatments with
professional non-ablative FP devices.
Conclusion: It is demonstrated that self-administered, lowdensity
FP treatments lead to objective and visible improvement
of photodamaged and photoaged skin with minimal discomfort
and downtime.
#87
EFFECTS OF DEVIATION FROM FOCAL PLANE
ON LESION DEPTH AND DIAMETER FOR
ABLATIVE FRACTIONAL PHOTOTHERMOLYSIS
Garuna Kositrana, Henry Chan
Dieter Manstein, Wellman Center for Photomedicine, Boston, MA
Background: Ablative fractional photothermolysis (AFP) uses
highly focused laser radiation. Therefore the lesion geometry is
highly dependent of the positioning of the target relative to the
focal plane. The effects of deviation from the focal plane on lesion
diameter and depth were investigated.
Study: In vitro, full thickness human skin samples and a
standardized phantom (paper pad, 3 M) were used to investigate
the lesion diameter and depth generated by an AFP system (deep
FX, Lumenis). Lesion geometry in tissue was assessed by
histological analysis of cryosections. Lesions created within the
paper phantom were simply assessed by counting the number of
perforated paper sheets and optical measurement of lesion
diameter. Deviation from focal plane ( 2toþ 3 mm) was achieved
by insertion of standardized spacers.
Results: Ablation depth was nearly identical for tissue and paper.
Deviation from the focal plane by 1 mm caused a reduction of
ablation depth by approximately 40% and an increase in spot size
by approximately 40%.
Conclusion: Minor deviation from focal plane has a marked
impact on lesion depth and diameter for AFP. A simple paper
phantom correlates well with tissue ablation and can serve as a
tool for quick and simple assessment of lesion geometry for AFP.
#88
PSEUDOMELANOMA FOLLOWING FRACTIONAL
CO2 LASER RESURFACING
Robert Gotkin, Deborah Sarnoff, Ritu Saini
NYU Medical Center, New York, NY
Background: Pseudomelanoma has been described as the
appearance of recurrent pigment following trauma, cryotherapy,
dermabrasion, various laser treatments and incomplete excision
of benign nevi. Differentiating between pseudomelanoma and
malignant melanoma can be extremely difficult, even for an
experienced dermatopathologist, because pseudomelanoma
exhibits atypical histologic features in common with malignant
melanoma. We report the first three cases of pseudomelanoma
following full face fractional CO2 laser skin resurfacing.
Study: A retrospective study of 112 consecutive patients who
underwent full face fractional CO 2 laser skin resurfacing for
rhytides, photodamage, acne scarring and dyschromia was
performed. Patients ranged in age from 22 to 85 and were
Fitzpatrick skin types I–V. There were 11 men and 101 women.
The lasers used were the DEKA SmartXide DOT and the
Cynosure SmartSkin CO2 lasers. Preoperative and post-operative
photographs were taken with the Canfield VISIA-CR photographic
system. The post-operative photographs were taken at 1 week,
1 month, 3 months, 6 months and 1 year following treatment.
Results: Both clinical and photographic analysis revealed three
patients who developed ‘new’ dark brown pigment in previously
flesh-toned nevi within the treatment area. Biopsy of the lesions
revealed the presence of irregularly nested proliferations of
slightly atypical melanocytes overlying superficial dermal
fibrosis.
Conclusion: We postulate that pseudomelanoma is likely to
occur more frequently following fractional, as opposed to fully
ablative, CO2 laser resurfacing. The persistence of melanin within
zones of thermal sparing may give rise to ‘new’ atypical pigmented
lesions. It is of utmost importance for the clinician to be aware of
the phenomenon of pseudomelanoma in order to avoid the pitfall
of misdiagnosis of malignant melanoma.
#89
ULCERATION OF MATURE SURGICAL SCARS
FROM NON-ABLATIVE 1,550 NM FRACTIONAL
LASER TREATMENTS ASSOCIATED WITH INTRA-
LESIONAL LIDOCAINE INJECTIONS
Gary Chuang, Mathew Avram, Zeina Tannous
Wellman Laboratories, Massachusetts General Hospital,
Harvard Medical School, Boston, MA
Background: Non-ablative fractional laser resurfacing has
gained increased popularity for treatment of scars, due to its
efficacy, shortened downtime, and safety profile for treatment of
scars in comparison to traditional ablative resurfacing. Topical
and injectable local anesthetics are routinely applied to the skin
prior to the laser treatment. Injected anesthetics are especially
useful due to their immediate effects. To date, ulceration with
non-ablative fractional laser treatment of surgical scars has not
been reported. Here, we report two cases of mature surgical scars
developing ulceration after treatments with a non-ablative
1,550 nm fractional laser treatment associated with intra-lesional
lidocaine injection.
Study: Two patients presented for treatment of mature
abdominal surgical scars. Both were treated with the same nonablative
1,550 nm fractional laser. Prior to these treatments, both
patients were injected with multiple intra-lesional 1% lidocaine
with 1:100,000 epinephrine. Each of these patients developed
ulceration shortly after non-ablative fractional laser resurfacing.
The first case was a 20-year-old man with a 26 cm linear surgical
scar on the abdomen from a biliary surgery as an infant. The scar
was treated with a non-ablative fractional 1,550 nm laser at a
pulse energy of 40 mJ (1,120 mm) and treatment level 8 (23%
surface area). Subsequent treatments were spaced 2–3 weeks
apart at the pulse energy of 50 mJ (1,224 mm) with level 9 (26%
surface area) and 60 mJ (1,300 mm) with level 10 (29% surface
area). The scar showed improvement with the laser treatments. A
few days after the third treatment, an ulceration was noted 6 cm
from one end of the scar. The second patient is a 47-year-old
woman who presented with a 38 cm abdominal scar from an
abdominoplasty 8 years ago. The scar was anesthesized with