Laser stands for Light Amplification by Stimulated Emission of Radiation. Light is a form of radiation. Laser is a concentrated, pure form of light. The light can be of different types, depending on what substance is used to emit the radiation or light, e.g., CO2 or rubies. Light can be visible or invisible to the naked eye. Depending upon what substances compose the target tissue and depending upon the exact type of laser light striking the target, a certain effect will occur. For example, the carbon-dioxide (CO2) laser, one of the most common, generates an infrared laser beam when energy is passed through carbon dioxide gas in the laser. The infrared laser beam (energy) produced by the CO2 laser is absorbed by water in the target tissues. The water boils into steam, causing the target cells to break apart. Other lasers produce a light that is absorbed only by hemoglobin, which is found in blood. These types of lasers would be very useful in avoiding cutting by passing energy through the eyeball without affecting any tissues except, for example, abnormal blood vessels on the back wall of the eyeball. This is because no other substance in the eyeball will absorb the laser before it reaches its target.

Presently, please remember that lasers are very expensive and that those costs will be passed along to the patient, one way or another. As in all forms of medicine and treatment, lasers may be good or bad, snake oil or miracle treatment, or neither. Some lasers are absolutely necessary and save much pain and suffering; they are an over-all benefit to mankind. The misuse of certain other lasers can be disastrous, wasting patient and public moneys, as well as causing suffering and scarring. Let us explore the ways that lasers work in order to guide the patient in deciding whether to undergo a procedure or seek a second opinion. By the way, the author recommends getting a second or third opinion from a reputable university medical center should the reader be in a decision-making quandary regarding the use of lasers in skin cancer.

The concentrated beam of light that is the laser can treat skin cancer by several mechanisms. First, as in the carbon-dioxide laser, the beam can be diffused on the surface of the skin causing damage similar to a peel or dermabrasion. The diffused carbon-dioxide laser has been used to treat precancers, but has a notoriously high rate of return of the precancers as the abnormal cells may have grown down hair pores where they resist treatment. The author uses the carbon-dioxide laser only on the lip for precancer, or actinic cheilitis. Second, the carbon-dioxide laser may be used in a concentrated pinpoint beam, almost as sharp as a scalpel. Laser beams usually cut by heating, damaging more cells than scalpel cutting. See Laser vs. Scalpel. Third, laser beams may act as described previously in this section for eye surgery. This use of laser surgery is rare in skin-cancer surgery and is currently usually involved with photodynamic therapy (PDT). Currently, PDT, although it has a high cure rate for skin precancer, has a miserably poor cure rate for skin cancer. However, PDT may see use in special situations or with further, as yet unknown, scientific advancements.

The author believes that the current use of laser to cut out tumors or perform Mohs Surgery is of little added value and is likely to destroy more tissue, scar more and seal blood vessels less than traditional scalpel surgery. Lasers in the cutting mode cut tissue by burning out cells causing thermal (head) damage on each side of the cut, whereas a scalpel cuts tissue almost by just separating a few cells apart; thermal artifact can make it more difficult for a pathologist to read/interpret the specimen being removed; even ultrapulse lasers have a degree of unwanted thermal damage on each side of the wound. See Laser vs. Scalpel. If there is an extra charge for the use of a laser, the author suggests added caution and seeking a second opinion before scheduling. The internal (inside the body) use of lasers is a totally different topic from that being discussed here for external (skin) treatment. Please seek another source for information on internal laser usage.

 

Paul J. Weber, M.D., P.A. 5353 North Federal Highway, Suite 400 Fort Lauderdale, FL 33308 Tel: 954-489-9800 | Fax: 954-489-0401