Tumour ablation by laser in dermatology

The role of CO₂ laser in plastic surgery and dermatology is nowadays well established. It has proved to be efficient within different contexts (haemorrhagic-infectious-necrotic ...) or on different tissues as skin, muscles and mucosae. But the role of lasers in oncologic cutaneous surgery is not as precise.The CO₂ laser is to be used in a focused mode, to realize the excision of tumour, whatever its size. The advantages lie in minimized blood loss, and in permitting all types of reconstruction (suture, graft or flap). Some clinical cases of photodynamic therapy are reported, but do not appear to be conclusive. Anyhow, PDT is still under investigation and does not seem to be ready yet for routine clinical use. The principle of tissue photo-ablation with excimer of Er-YAG lasers shows some possible interest in the case of tumour treatment. But, here again, this technique has not yet proved to be for any real advantage, as far as technology is concerned. Whatever the type of laser to be used, one basic principle is to completely excise the tumour to meet the classical requirements of oncologic surgery, i.e. to be far enough from the lesion, and to get a microscopic identification of the whole specimen.