To better understand lasers, please refer briefly to the Web site subsection LASER before continuing. Still one the most common lasers in use in a doctor's office or hospital is the carbon-dioxide (CO2) laser for skin-cancer surgery. In the cutting mode, no matter how ultrapulse, ultrafine or ultra-"whatever" your surgeon says the laser is, consider this fact: The CO2 laser cuts by heating and boiling cells. On either side of the area where the laser beam is used to cut your skin, there will be cells killed by boiling. More cell death means more scarring, period. Tissues only glue, mend or repair themselves by forming fibrous tissue = scar. A good, sharp, old-fashioned scalpel (surgeon's knife) cuts merely by separating cells. On each side of a scalpel cut around a tumor in your skin will be many more live cells than on each side of a laser cut. Which do you think causes less trauma (damage) to your tissue, separating cells or boiling cells? As you can see, for skin cancer there is nothing magical about the use of a CO2 laser rather than a scalpel for skin-cancer surgery. In fact, for Mohs Surgery, the char or thermal effect of a laser will result in less "readable" tissue for the Mohs surgeon to examine under the microscope.

Some surgeons may respond that there is less bleeding with laser surgery. This may be true for some areas like the eyelid, but for most areas, the response is untrue. First, proper anesthesia and settling time markedly reduce bleeding. Second, CO2 laser seals less than one millimeter into a blood vessel. Electrosurgery, which is done with scalpel surgery, and is a "gold standard" of bleeding control, stops bleeding up to three millimeters down a vessel, forming a much better plug that is likely to seal the vessel longer and tighter. Applications of electrosurgery are focused and not all over, like those of a laser. Less applied energy means less tissue damage which means less scarification. A laser does not seal tissue together or weld tissue to any degree in skin-cancer surgery. People are not made of metal; melted tissue is dead tissue. Additionally, the body must remove dead tissue before it can be replaced.

Beware the "new" laser. Some surgeons try to sell the public on new techniques to bring in patients and, hence money. For example, in the late 80's and early 90's, many surgeons published articles about how wonderfully lasers treated many skin tumors and conditions. Some reports were true, but others were overblown. Some large dermatologic centers, like the one at The Cleveland Clinic, in Cleveland, Ohio perpetuated the "buzz." Many other doctors around the country found that the published results from this center could not be reproduced. A period of debunking the "fantastic" laser results of the 1990's eventually resulted.

In a nutshell, laser surgery is a fast-changing science. Presently, as of the year 2003 the necessity of lasers in skin-cancer surgery is debatable. However, times change rapidly... and eventually our opinions may change with technological advancements. Until the next update . . .

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