When surgery or radiation therapy cannot be used to remove the common precancerous skin lesion lentigo maligna, carbon dioxide laser ablation may be a useful alternative. In this treatment, the carbon dioxide laser vaporizes water-containing cells.

Lentigo maligna lesions are often seen in older people with a history of chronic sun damage. The lesions, frequently located on the head and neck, may progress to lentigo maligna melanoma. Surgical excision is the gold-standard treatment for both conditions, but complete excision of large lesions on the head and neck is not always feasible.

A retrospective case series review of all 75 patients with primary lentigo maligna diagnosed and treated in London, Ontario, Canada, from July 1991 through June 2010 indicated that 73 patients chose to undergo treatment. The subjects ranged in age from 39 to 93 years (mean age 64.8 years).        

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Recurrence rates were

  • 4.2% for surgical excision (1 of 27 patients) over a median follow-up of 16.6 months
  • 29.0% for radiation therapy (9 of 31 patients) over a median follow-up of 46.3 months
  • 6.7% for carbon dioxide laser ablation (1 of 15 patients) over a median follow-up of 77.8 months.

The trend toward lower recurrence rates with surgical excision and carbon dioxide laser ablation was not statistically significant.

The investigators concluded in Archives of Facial Plastic Surgery (2011;13[6]:398-403) that carbon dioxide laser ablation can treat large lentigo maligna lesions in cosmetically sensitive regions of the head and neck in a short period of time, with minimal morbidity. Thus, the procedure could have a role as an alternative treatment for lentigo maligna in patients who cannot undergo standard treatments.