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
McLeod M, Franca K, Ferris K, Nouri K. 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
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