Deep Shave Excision of Macular Melanocytic Nevi with the Razor Blade Biopsy Technique

BACKGROUND: Shave excision is an established surgical method for removing benign skin lesions for cosmetic and functional reasons. Usually superficial shave excision is performed with a common scalpel blade for the removal of papular nevi. However, there is little known about deep shave excision of macular melanocytic nevi with the razor blade technique. OBJECTIVE: The present study was undertaken to evaluate the cosmetic outcome of deep shave excision of macular melanocytic nevi with the razor blade technique. Moreover, its potency for sufficient removal of these lesions was investigated. METHODS: Within routine skin cancer screening 45 outpatients with a total of 77 macular melanocytic nevi were prospectively recruited. Deep shave excisions of these lesions were performed with a double-edged razor blade followed by chemical hemostasis. Histologically all specimens were processed and evaluated in a routine manner. After 6 months the physician and patients evaluated the shave sites for cosmetic outcome with a score graded from 1 to 4 (1 = excellent; 2 = good; 3 = moderate; 4 = poor). RESULTS: Histologically 88% (68 of 77) of the melanocytic lesions were described as completely excised and 60% (46 of 77) were diagnosed as atypical melanocytic nevi; 12% (9 of 77) of the nevi were incompletely excised on the depth. On average, the deep margin of the specimens (n = 77) was 0.5 mm (range 0-1.8 mm) and the lateral margin was 2 mm (range 0.3-8.2 mm). After 6 months 56 shave sites could be reassessed. We observed mild hypopigmentation in 52% (29 of 56), hyperpigmentation in 32% (18 of 56), and erythema in 23% (13 of 56). Recurrent nevi occurred in 13% (7 of 56). The evaluation of the cosmetic outcome by the patients (mean score 1.7) achieved better results than the evaluation by the physician (mean score 2.5). The cosmetic results showed no significant (P >.05) differences in various anatomic sites. CONCLUSION: Our data confirm that deep razor blade excision presents a highly useful and inexpensive method for the removal of macular melanocytic nevi that yields adequate specimens for pathologic interpretation. We consider that shave excision with the razor blade technique is potentially much less scarring than full-thickness scalpel excisions of nevi. In particular, this is of great significance for patients with multiple nevi, such as dysplastic nevi syndrome.     

Radical Resection of Giant Congenital Melanocytic Nevus and Reconstruction With Meek-Graft Covered Integra Dermal Template

BACKGROUND: Giant congenital melanocytic nevi represent a surgical challenge, particularly in cases in which the size of the nevus exceeds certain extend and malignant transformations have to be considered. OBJECTIVE: To discuss through case report considerable surgical options when extensive giant congenital melanocytic nevi with malignant transformation are encountered. METHODS: We present an unusual case of a giant congenital melanocytic nevi of the entire back of a 44-year-old patient. To achieve radical resection with direct appropriate wound closure and acceptable outcome, the integument of the entire back was excised and covered with Integra, followed by split-thickness skin grafting after stable integration of the matrix. RESULTS: The approach resulted in a complete excision of the tumor and acceptable cosmetic and excellent biomechanical outcome. CONCLUSION: The introduced practice demonstrates a useful alternative to established methods, particularly if tumor excision in large areas and subsequent wound closure might be achieved in one procedure.     

Acquired Melanocytic Lesions and the Decision to Excise: Role of Color Variegation and Distribution as Assessed by Dermoscopy

BACKGROUND: Because melanoma may sometimes be difficult to differentiate from nevi with clinical atypia, many benign lesions also undergo surgical removal. OBJECTIVE: To assess color type and distribution in dermoscopic melanocytic lesion images and to analyze the influence of color parameters on the diagnostic process and the decision to excise. METHODS: Overall, 603 images, referring to 112 melanomas and 491 nevi, were retrospectively subdivided into four groups: "clearly benign," "follow-up," "dermoscopic atypical nevi," and "dermoscopic melanomas," according to their dermoscopic aspects. The frequency of color type, number, and asymmetry were evaluated on digital images. RESULTS: With respect to lesions not eligible for excision according to dermoscopy (but excised for cosmetic reasons), those excised with a suspicion of malignancy showed a higher number of colors, whose distribution was also more asymmetric. Moreover, the frequency of the presence of black and blue-gray progressively increased from clearly benign lesions to atypical nevi and dermoscopic melanomas. CONCLUSION: In dermoscopic images, color parameters are essential elements for the diagnosis of atypical nevus, which can be differentiated from both a clearly benign lesion and a melanoma. Furthermore, pigmentation asymmetry and the presence of blue-gray represent the main color features, which should lead to the decision to excise.     

Excision of giant nevi in children--how should the wound be closed?

The cases of two children with giant nevi of the trunk that were excised and closed in early childhood are presented. Both had cosmetic and functional deformities and were treated by scar excision and skin grafting. The 2 cases demonstrate that excision and closure of giant nevi in young children should be discouraged, as it can result in distortion of surrounding structures.     

Postsurgical Use of Imiquimod 5% Cream in the Prevention of Earlobe Keloid Recurrences: Results of an Open-Label, Pilot Study

Background. Traditional surgical modalities for the management of earlobe keloids are often associated with high recurrence rates. A recent report suggests that imiquimod 5% cream can be effective in the prevention of keloid recurrences after surgical excision.
Method. To establish the safety and efficacy of imiquimod 5% cream in the prevention of recurrences of excised earlobe keloids.
Methods. Patients who attended a dermatologic surgery clinic for the treatment of earlobe keloids were recruited into the study. Earlobe keloids underwent parallel shave excision. Imiquimod 5% cream was applied daily for 8 weeks followed by an observation period of 16 weeks. In patients who presented with bilateral earlobe keloids, paired comparisons of imiquimod versus intralesional steroid injections were performed.
Results. Eight earlobes were treated with imiquimod 5% cream after parallel keloid removal. Twenty-four weeks after surgery, six (75%) remained recurrence free. Four patients underwent bilateral paired comparisons. At the end of the observation period, two patients (50%) remained recurrence free in the imiquimod-treated areas while experiencing recurrences in the intralesional steroid–treated areas. Local irritation secondary to imiquimod application required rest periods in three cases. In all cases, patients were able to resume therapy and completed the study without further complications.
Conclusion. Although small and uncontrolled, the results of this open-label, pilot study suggest that imiquimod 5% cream may prove to be a reasonably effective adjuvant therapeutic alternative for the prevention of recurrences in excised earlobe keloids.
DR. Martín-García HAS BEEN A CONSULTANT AND SPEAKER FOR 3M PHARMACEUTICALS.     

Long-term outcome of benign fibroadenomas treated by ultrasound-guided percutaneous excision

Abstract:  Surgical as well as conservative treatment has been described for fibroadenomas. Both have disadvantages. A minimally invasive treatment, ultrasound-guided, vacuum-assisted percutaneous excision has been shown to facilitate the removal of all imaged evidence of benign breast lesions, including fibroadenomas up to 3 cm in diameter. This study is performed to assess the long-term outcome of ultrasound-guided percutaneous excision as a minimally invasive treatment for fibroadenomas. A retrospective review of 69 consecutive fibroadenomas treated with ultrasound-guided percutaneous excision between May, 2001 and December, 2005 was carried out. All these lesions underwent percutaneous excision of all imaged lesion evidence. Clinical and sonographic follow-up was recommended for all patients every 6 months. Initial size, location, and patient age were recorded for each treated lesion. Of 69 lesions treated, 52 were available for follow-up. The median follow-up period was 22 months, with a range of 7 to 59 months. At 6 months, there were no fibroadenoma recurrences. Follow-up sonography demonstrated recurrences in 13 lesions distributed across eight patients. The overall recurrence rate was 15% (8/52) with an actuarial recurrence rate of 33% at 59 months. All of the recurrences were in lesions which were larger than 2 cm in size at initial presentation. Our data suggest that the mechanism of recurrence is the regrowth of retained lesion fragments too small to be detected by ultrasound—not the incomplete excision of all imaged lesion evidence. Despite successful percutaneous excision, fibroadenomas do recur. Lesions smaller than 2 cm in size, so treated, do not need additional therapy or surveillance. Fibroadenomas larger than 2 cm are prone to recurrence and require additional treatment.     

Results of local excision of benign and malignant rectal lesions

Local excision of selected rectal cancers is an acceptable alternative to radical surgery. The results of local excision of various rectal lesions using either the transanal or trans-sacral approach were reviewed over a 10-year period at this institution. A total of 56 procedures were performed on 47 patients (50 transanal/six trans-sacral). The trans-sacral approach was used six times on five patients for lesions averaging a distance of 8 cm from the anal verge. The transanal approach was used 50 times on two patients for lesions occurring at an average distance of 5 cm from the anal verge. Twenty-six malignant lesions were excised (25 transanal/one trans-sacral) with pathologies ranging from poorly to well-differentiated adenocarcinoma. Staging included 12 T1 lesions (46%), 10 T2 lesions (38%), and four T3 lesions (16%). Eighteen malignancies were completely excised and recurrence occurred in four of 18 (22%) with an average follow-up of 2.3 years (range 0-10 years). Local recurrence occurred in two patients (T1 and T2 lesions) and recurrence was in the form of distant metastasis in two patients (two T3 lesions). Three of the recurrences occurred in patients with T3 lesions (three of four; 75%), two occurred in a patient with a T2 lesion (two of 10; 20%), and one occurred in a patient with a T1 lesion (one of 12; 8%). There were no cancer-related deaths during the study period. Twenty-six premalignant lesions (adenomatous polyps) and four benign lesions were excised (25 transanal/five trans-sacral). Local recurrence occurred 10 times with an average follow-up of 1.8 years. In conclusion local excision of certain rectal cancers is an acceptable alternative in the treatment of these malignancies.     

Do basal cell carcinomas recur after complete conventional surgical excision?

For 1378 patients treated in the 11 years 1988-1998 by conventional excision of 1635 basal cell carcinomas, 1516 first index lesions were histologically completely excised. All patients having more than one BCC excised were identified from the data base from 1988 to 2003 to give minimum 5 years follow for last treated primary lesions in 1998. Measured clearance margins around the initial lesions at or near sites of presumptive recurrent lesions were noted and the lesions recorded photographically. All incompletely excised lesions whether or not re-excised were excluded. The median age for all patients was 70 years. Over minimum 5 years follow up, six patients developed nine subsequent lesions contiguous with the scar or graft repair of primary index lesion excision site (probable recurrences). The median interval to recurrence was 41 months (4 months-8 years 10 months), with median lateral clearance margin around the primary tumour of 2 mm (0.3-6.8 mm). A further nine patients developed 11 new lesions near (within 1cm of) the scar or graft of primary index lesion excision site (possible recurrences). The median interval to recurrence was 59 months (1 year-8 years 6 months). The median lateral clearance margin around the primary tumour was 4.1 mm (0.8-5.8 mm). For the two groups combined the maximum recurrence rate expressed as a percentage of index lesions was 1.3% (20/1516). Two thirds of possible and probable recurrences occurred in the temple and forehead, although these sites represented only 22% of all lesions, which may rather suggest new lesions in an area of field change as opposed to residual disease. The measured clearance margins reported here perhaps suggest that some original lesions may well have been completely excised primarily and many 'recurrences' were new primaries. These figures indicate there is a low order of probability for the incidence of recurrent basal cell carcinoma during minimum 5 years follow period after conventional surgical excision and conventional histological assessment of tumour resection margins.     

Oncoplastic breast surgery for the management of giant and multiple benign breast lesions

BACKGROUND: Oncoplastic breast surgery has become an integral component in the management of breast cancer. Benign breast lesions, especially when multiple or giant, constitute a difficulty in obtaining complete wide excision with minimal breast deformity and minimal small scars in addition to the high risk of recurrence. In this article, we present the results of management of multiple scattered and giant breast lesions using oncoplastic techniques. METHODS: Twenty-seven patients with giant and multiple scattered breast lesions were operated upon by 2 oncoplastic techniques, namely the round block and reduction mammoplasty technique. RESULTS: The cosmetic and oncological results were satisfactory from all aspects. There were no cases of breast deformity, all scars were acceptable and no reported cases of recurrence. CONCLUSIONS: Oncoplastic techniques can be applied with success in cases with giant and multiple benign breast lesions with favorable cosmetic and oncological outcome.     

Double-Blind, Randomized, Placebo-Controlled, Prospective Study Evaluating the Tolerability and Effectiveness of Imiquimod Applied to Postsurgical Excisions on Scar Cosmesis

Background. It has been reported that topical application of imiquimod 5% cream induces interferon-α, an antifibrotic cytokine.
Objective. To determine the tolerability and effectiveness on the cosmetic outcome of the application of imiquimod to postsurgical excision sites.
Materials and Methods. A prospective, double-blinded, randomized, vehicle-controlled trial was conducted among 20 patients with two skin lesions clinically diagnosed as melanocytic nevi. Imiquimod 5% cream was applied to one of the sutured surgical wounds starting the night of the excision nightly for a period of 4 weeks. The second sutured excision site was treated with vehicle cream. Scar cosmesis, erythema, pigmentary alterations, induration, tenderness, and pain were assessed using a visual analogue scale 2, 4, and 8 weeks after surgery.
Results. Eighteen subjects completed the study, with a total of 36 excision sites; no wound site dehisced, and no signs of infection were noted. Surgical wounds treated with imiquimod had more erythema, pigmentary alterations, and lower cosmesis rated by the investigator compared with wounds treated with placebo, both becoming nonsignificant in further evaluations. For pigmentary alterations, induration, and cosmesis rated by the patients, no statistically significant difference between treatment groups was observed at week 8.
Conclusion. Treatment of surgical excision-site wounds with imiquimod was well tolerated and without serious adverse events. Evaluations for cosmesis of placebo-treated surgical sites were better than imiquimod-treated sites at week 8, becoming nonsignificant later.
DR. BERMAN IS A CONSULTANT AND ON THE SPEAKERS BUREAU FOR 3M PHARMACEUTICALS, WHICH SUPPLIED THE MATERIALS USED IN THIS STUDY. THE UNIVERSITY OF MIAMI-Miller SCHOOL OF MEDICINE RECEIVED STUDY SPONSORSHIP FUNDING FROM 3M PHARMACEUTICALS.     

Efficacy and Safety of Short-Pulse Erbium:YAG Laser in the Treatment of Acquired Melanocytic Nevi

BACKGROUND: Various laser systems have been used in the treatment of acquired melanocytic nevi. However, CO2 lasers may cause scarring, and some nevi cannot be removed with pigment-specific lasers completely. To date, no study has evaluated the efficacy and safety of an erbium:yttrium-aluminum-garnet (YAG) laser, with its small penetration depth and fewer adverse effects, in the treatment of acquired melanocytic nevi. OBJECTIVE: To investigate the efficacy and safety of the short-pulse erbium:YAG laser in the treatment of acquired melanocytic nevi. METHODS: The study included 28 nevi in 14 patients. The lesions were pigmented, flat, or just palpable nevi. Nevi were irradiated with single-pulse laser energy of 1,000 mJ and a pulse duration of 300 microseconds. Fluences between 5.2 and 14.4 J/cm2 were used. Four months following laser treatment, the entire lesion was excised. Each specimen was histopathologically and immunohistochemically examined for the presence of nevus cells. RESULTS: Clinically, all of the nevi and, histopathologically, 27 of 28 nevi (96%) were completely removed without scarring. Post-inflammatory hyperpigmentation was seen in two patients and hypopigmentation in three patients. CONCLUSIONS: Short-pulse erbium:YAG laser treatment is an effective and safe method for removing acquired melanocytic nevi.     

HMB-45 staining of dysplastic nevi. Support for a spectrum of progression toward melanoma

Dysplastic nevi are melanocytic tumors that occupy intermediate positions in the spectrum of melanocytic proliferations. Although they are invariably cured if completely excised, their biologic potential if left untreated is unknown. We examined a series of such lesions with HMB-45, a melanocyte-specific antibody, in order to explore protein expression within these borderline lesions. HMB-45 has previously been shown to label intraepidermal melanocytes within melanomas and within all nevi. Intradermal melanoma cells also label with HMB-45, but dermal nevus cells within common melanocytic nevi do not normally stain. In contrast, we found mild to moderate staining of nevus cells within the papillary dermis of dysplastic nevi and within residual nevus cells adjacent to malignant melanomas. In the same lesions, we demonstrated strong staining of intraepidermal melanocytes. Thus, dermal nevus cells within dysplastic nevi and within residual nevus cells adjacent to malignant melanomas are expressing low-level amounts of a protein expressed by melanoma cells, but not by dermal nevus cells within wholly benign melanocytic tumors. This lends support to the concept of these lesions as precursor lesions with undetermined biologic potential.     

Shave Excision of Benign Facial Melanocytic Naevi: A Patient''s Satisfaction Survey

BACKGROUND: Shave excision is a simple and quick procedure that is widely used for removal of benign naevi. Limited published data are available on patient acceptability of this procedure or its potential cosmetic outcomes. OBJECTIVES: To assess the patient's satisfaction with the procedure, to assess the risk of recurrence, and to determine the patient's perception of the scar. METHODS: Questionnaires were sent to 93 consecutive patients who had shave excision of benign facial naevi. RESULTS: Seventy-six patients (82%) with a total of 83 naevi responded. Twenty-eight percent of naevi were reported to have recurred 12 months after shave excision. A significantly higher recurrence rate was found with hairy naevi (41%, P= 0.04). More than half of the patients reported no scar or had a white and flat scar. Nineteen percent of scars were depressed, and 15% were raised; 7% were pigmented. The majority of patients were satisfied with the results. CONCLUSIONS: Despite a high recurrence rate, most patients were satisfied with the cosmetic outcomes after shave excision of benign facial naevi. The results of this study have helped us to provide our patients with more accurate information regarding cosmetic outcomes.     

Persistent (recurrent) Spitz nevi: a histopathologic, immunohistochemical, and molecular pathologic study of 22 cases

This report describes 22 Spitz nevi that seemed to have been clinically removed but persisted and clinically recurred at the biopsy site. These were evaluated in terms of histopathology, immunohistochemistry, and molecular pathology using comparative genomic hybridization (CGH) and fluorescent in situ hybridization. One of these 22 lesions was originally reported as an atypical melanocytic proliferation with some features of a Spitz nevus and was included in the study set at an early stage but was later recognized as melanoma after metastasis to regional lymph nodes 3 years after the local recurrence. We noted four histopathologic patterns in the recurrent lesions: 1) a predominantly intraepidermal pattern resembling "pseudomelanoma" as seen in recurrent "common" melanocytic nevi, 2) a compound, mostly nested pattern above or within a scar that was nearly identical to the originally biopsied Spitz nevus, 3) a nodular growth pattern that closely simulated invasive melanoma, and 4) a desmoplastic pattern resembling an intradermal desmoplastic Spitz nevus. Although the majority of recurrent lesions exhibited asymmetry and pagetoid spread, the dermal component usually had a low mitotic rate and retained architectural and cytologic maturation, which allowed distinction from invasive melanoma. Except for the metastasizing melanoma, the immunostaining pattern with S-100 and HMB-45 was identical to that previously reported for Spitz nevi. Ki67 revealed a very low proliferation rate in all cases, including the melanoma. CGH performed in 10 cases yielded results consistent with Spitz nevi in eight cases. The remaining two cases showed CGH profiles more typical of melanoma, and one of these was the above-referenced case of melanoma, proven by metastasis. Although ancillary molecular techniques such as CGH are of great help in distinguishing these from melanoma, until such techniques become widely available we advocate complete but conservative excision of any recurrent Spitz nevus.     

Analysis of mutations in B-RAF, N-RAS, and H-RAS genes in the differential diagnosis of Spitz nevus and spitzoid melanoma

A definite diagnosis cannot be established based on histologic features alone in a large number of Spitz nevi and spitzoid melanomas. In a vast majority of common benign and malignant melanocytic lesions, B-RAF and N-RAS mutations were described, but these were not detected in Spitz nevi. In contrast, H-RAS mutations were frequently encountered in Spitz nevi, but only rarely in melanomas. To date, B-RAF mutation analysis has not been reported in atypical Spitz nevi, and there are only a few reports of it in spitzoid melanomas. We analyzed 96 formalin-fixed, paraffin-embedded spitzoid melanocytic lesions for hotspot mutations in B-RAF, N-RAS, and H-RAS genes to test the assumption whether mutation analysis would assist a more accurate diagnosis of spitzoid melanocytic lesions, which are notoriously difficult to classify. B-RAF or N-RAS mutations were observed in 31 of 36 (86%) spitzoid melanomas, and in 6 of 7 (86%) spitzoid melanoma metastases. In contrast, none of the 14 Spitz nevi and none of the 16 atypical Spitz nevi had mutations in any of the three genes. A B-RAF or N-RAS mutation was found in 8 of 23 (35%) spitzoid lesions suspected for melanoma. H-RAS mutations were detected in 4 of 14 (29%) Spitz nevi, in 3 of 22 (14%) atypical Spitz nevi, in 1 of 15 (7%) spitzoid tumors suspected for melanoma, but in none of the spitzoid melanomas. These results strongly indicate that Spitz nevi and spitzoid melanomas are genetically unrelated entities. Furthermore, we can conclude that mutation analysis may be useful as an additional diagnostic tool to distinguish between benign and malignant spitzoid lesions.     

Atypical genital nevi. A clinicopathologic analysis of 56 cases

Atypical genital nevi are rare melanocytic lesions that most commonly arise on the vulva of young women. They are currently regarded as nevi of special sites, in that despite histologically worrisome features, their clinical behavior is reportedly benign. However, only few studies with limited follow-up data are available. To better characterize the clinical presentation and behavior of these lesions and to further delineate their histologic features, we retrieved 56 atypical genital nevi arising in the lower female genital tract from our departmental and consultation files. The 56 lesions arose in 55 female patients with a median age of 26 years (range, 6 to 54 y). The dominant histologic feature was a lentiginous and nested junctional component composed of prominent round or fusiform nests, which often showed retraction artifact and/or cellular dyscohesion. Cytologic atypia was mild in 11 cases (20%), moderate in 34 (60%), and severe in 11 (20%). Ten cases (18%) showed focal pagetoid spread, with extension to the granular layer and stratum corneum in 1 case. The atypical junctional melanocytic proliferation was associated with a large common dermal nevus component that dominated the lesion in 26 cases (46%). Adnexal spread (46%) and nuclear atypia of melanocytes situated in the superficial dermis (39%) were relatively common, but dermal mitoses (7%) were uncommon and maturation was present in all cases. A broad zone of dense eosinophilic fibrosis within the superficial dermis was a frequent finding (41%). Clinical follow-up was available in 45 cases (80%) with a median follow-up period of 3.5 years (range, 1 to 16 y). Only 1 lesion recurred, 1.5 years after the initial excision. The original nevus in this patient had only mild cytologic atypia and was present at the margins of excision. The recurrent/persistent nevus was reexcised, and there was no further clinical recurrence in 11.5 additional years of follow-up. Our data support the hypothesis that atypical genital nevi have a benign clinical course despite their occasionally striking cytologic and architectural atypia. Awareness and recognition of this group of melanocytic lesions is important to avoid over diagnosis as melanoma with subsequent wide excision and possibly sentinel lymph node biopsy.     

Presentation and prognosis of local recurrence after total mesorectal excision

Objective  The aim of this study was to describe the presentation, treatment and prognosis of local recurrences following total mesorectal excision for rectal adenocarcinoma.
Method  Between 1999 and 2002, 201 patients were treated with total mesorectal excision for mid or low rectal cancer and were followed up prospectively.
Results  Overall 2-year survival was 85%. The 2-year recurrence rate was 8%. Eighteen patients developed local recurrence at 3–60 months.
Nine recurrences originated from the pelvic sidewall. These recurrences were symptomatic in 90% of patients. Only two patients were reoperated with a R0 resection and were alive without local recurrence after 19 and 31 months. The seven others died within 9 months.
Nine recurrences originated from an anastomotic suture line. Only two had symptoms. A R0 surgical resection was performed in all patients with a 67% sphincter conservation rate. After 26-months of median follow-up (range 7–58), all patients were alive.
Conclusion  Half of the local recurrence after total mesorectal excision was located at the anastomotic site. Rectoscopic examination should be performed regularly to detect these anatomotic recurrences that are accessible to a R0 itérative resection.     

532-nm Diode Laser Treatment of Seborrheic Keratoses with Color Enhancement

BACKGROUND Seborrheic keratoses (SKs) are benign cutaneous tumors of the epidermis. Localization in the head and neck areas can produce an unsightly appearance. Recurrence after curettage, shave excision, cryoablation, or chemical peel can be common.
OBJECTIVE The objective was to determine if laser ablation with the 532-nm laser and color enhancement is effective in removing SKs.
MATERIALS AND METHODS A total of 326 patients who presented with 1,567 benign SKs were treated with the DioLite (Iridex Corp.) and VersaPulse cosmetic (Coherent Inc.) 532-nm diode lasers with color enhancement using a red marker or ferric subsulfate. The DioLite was set at 27 to 30 J with a 2- to 3-mm spot size, and a 10-ms pulse width was used for ablation. The VersaPulse was set at a lower energy of 9.5 to 12 J/cm² with a 3-mm spot size, 3- to 6-Hz repetition rate, and 10-ms pulse duration for ablation. All patients were Caucasian.
RESULTS Complete resolution of the SKs occurred in 93% of lesions. Seven percent of SKs required a second round of laser treatment for incomplete ablation. There were no cases of hyperpigmentation or hypertrophic scar formation of the skin following laser treatment. Hypopigmentation occurred in 6% of patients and was associated with old, chronic, or recalcitrant lesions.