HOT TOPICS
 
 

Laser-Assisted Removal of
Pigmented Lesions

In 1983, Dr. Rox Anderson of Harvard University published his landmark paper on “selective photothermolysis” in the distinguished journal, Science. Dr. Anderson proposed that lasers could be “tuned” so that they only injured specific targets in the skin, while basically “ignoring” other structures. At that time, he was interested in removing vascular birthmarks known as “port wine stains” and “hemangiomas” from affected children.

Dr. Anderson’s theory revolutionized treatment of these vascular lesions, and opened the door to safe and effective removal of many targets in the skin, including unwanted spider veins, brown spots, some pigmented birthmarks, excessive hair, and tattoos. The last decade has seen a further renaissance in laser technology that has resulted in even more sophisticated and cost effective treatment for pigmented lesions.

How is the treatment performed?
The entire procedure takes approximately 10-30 minutes. For smaller areas, a topical anesthetic cream can be applied to lessen the moderate discomfort associated with therapy. In some cases, an oral pain pill is taken 1 or 2 hours to the procedure to further improve your comfort. Protective eyewear is worn, and the brown pigmentation is “painted” with the laser light. After treatment, a bandage is placed, and you are allowed to return to work or social activities with minimal restrictions.

What can I expect after therapy?
Immediately following the procedure, each treated area appears white due to the formation of microscopic gas bubbles. This white appearance fades after 30-60 minutes, and the treated areas then appear scratched, with a small amount of scabbing. This scabbing is treated with dilute vinegar soaks and Vaseline application 1-2 times each day. The scabbed area heals in 2-4 weeks. The unwanted brown spot(s) fade gradually over 4-8 weeks. Treatment sessions are usually scheduled every 8 weeks, to allow adequate time for healing and fading.

What are the risks?
Laser removal is extremely safe, with almost no risk of serious side effects. In the vast majority of patients, the pigmented lesion is simply erased and treated skin looks exactly like surrounding skin. A minority of patients experiences some textural or pigmentary changes. This may require treatment with bleaching creams. Overall, the risk of complications is less than 1%.

What are the limitations of laser removal of pigmented lesions?
In a few patients, the lesion may lighten but not completely disappear. Treatment success can be somewhat less predictable on the legs, particularly on thicker lesions. For some thicker lesions, liquid nitrogen cryotherapy may be more effective than the laser.

What is the cost of laser treatment?
Although the costs have decreased in recent years, treatment is still expensive because of the complex technology involved. A Versapulse laser costs approximately $185,000.

The price depends on the type of pigmented lesion being treated. For example, removal of “lentigines” (sun-induced brown spots, or “liver spots”) on the arms only involves one or two treatment sessions in most patients. At the other extreme, effective treatment of some congenital or acquired brown birthmarks (e.g. “Becker’s nevus”, “Nevus spilus”) may require multiple sessions. The cost is usually $350 – $650+ per treatment session. Treatment is considered cosmetic, and is not covered by insurance. Payment for each treatment session is due at the time of scheduling.