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Nov/Dec 2012

Use of Carbon Dioxide Laser to Treat Lentigo Maligna and Malignant Melanoma In Situ, Lentigo Maligna Type

Arch Facial Plast Surg. 2012;14(6):462. doi:10.1001/archfacial.2012.874

We read with great interest the recent article published by Lee et al titled “Carbon Dioxide Laser Treatment for Lentigo Maligna: A Restrospective Review Comparing 3 Different Treatment Modalities.”1

While the carbon dioxide ablative laser may offer some usefulness as a third-line treatment, the nature of its emitted light has stark limitations. Most notably, the 10 600-nm wavelength is not actively absorbed by melanocytes; instead, the laser targets water as a chromophore. In addition, the 10 600-nm wavelength may not penetrate deep enough to destroy the atypical melanocytes extending down the periadnexal structures, using reasonable fluences.2,3 Future studies may wish to explore a laser wavelength that is more actively absorbed by melanocytes, such as using indocyanine green as a photosensitizer followed by treatment with the titanium sapphire laser.4,5