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January 27, 1984

Treatment of Intraepithelial Neoplasia

Author Affiliations

Laser and Dysplasia Clinic Campbell, Calif

JAMA. 1984;251(4):470. doi:10.1001/jama.1984.03340280026017

To the Editor.—  In a recent QUESTIONS AND ANSWERS column,1 the use of the CO2 laser in the treatment of cervical intraepithelial neoplasia (CIN) is discussed. There are several misconceptions that need to be clarified.First, the term laser cautery is used more than once. When used at high power densities, the CO2 laser causes vaporization of tissue, resulting in its removal. While there is some thermal damage to the underlying tissue, this is minimal, and less than 1 mm deep. In contrast, hot or cold cautery results in necrosis to an unknown depth of tissue, rather than the actual removal of tissue. Laser treatment of CIN is, therefore, more comparable with conization than cauterization.Two basic types of laser conizations may be done. In the vaporization cone, the entire transformation zone is vaporized to a measured depth of at least 6 mm. In this type of