Mohs surgical scars benefit from intraoperative laser treatment

Key Points

Chicago - Intraoperative fractional CO₂ laser treatment of wounds resulting from Mohs micrographic surgery significantly improves scar cosmesis at two to three months postoperatively, according to the results of a randomized, split-scar study reported by David Ozog, M.D., at the 2010 joint annual meeting of the American Society for Dermatologic Surgery and American Society of Cosmetic Dermatology & Aesthetic Surgery in October.

The repair length averaged 5.3 cm, and the surgical sites included seven facial and three off-face locations. Half of the scar was randomized to the laser treatment (UltraPulse, Lumenis) performed after placement of the buried sutures and the other half had no laser treatment.

Results

Results from assessments of scar appearance by both patients and a panel of three treatment-masked dermatologists reviewing photographic images taken at last follow-up showed statistically significant differences favoring the use of intraoperative fractional CO₂ laser treatment. There was good agreement in the patient and physician ratings, and the benefit for the laser intervention was consistent for both facial and off-face surgical sites.

"There are many reports describing the use of a variety of techniques for improving scar appearance, including manual dermabrasion, intralesional corticosteroid injections and use of ablative and nonablative lasers," Dr. Ozog says. "These procedures are usually not performed until six to eight weeks postoperatively, which is when patients are usually first evaluated for possible scar revision."

"However, treatment performed at the time of the primary surgery offers potential benefits for patients and surgeons, as it could save time and money for patients who are likely to need revision," he says. Dr. Ozog is director of cosmetic dermatology, department of dermatology, Henry Ford Hospital, Detroit.

"To our knowledge, ours is the first study to look prospectively at intraoperative use of fractional CO₂ laser treatment using a controlled split-scar design, and the results of this intervention are promising," he says.

"However, follow-up is early, and further study is needed with longer follow-up to see if the results are maintained and to see if they can be validated in a larger population with greater wound diversity," he says.

Dr. Ozog cites the experiences of Dr. Moy as well as two publications for the genesis of the idea of investigating intraoperative laser treatment to improve scar outcome. The first paper, a 1958 article by Albert Kligman, M.D., reported a benefit for intraoperative dermabrasion, and the second was a 1999 article by Rubin and Greenbaum, who performed intraoperative treatment with a fully ablative CO₂ laser.

"However, neither dermabrasion nor ablative CO₂ resurfacing can be used safely off the face, and even on the face these techniques can cause hypopigmentation and scarring," he says.

"Treatment with the fractional CO₂ laser is not without risk, as it has also been reported to cause scarring, especially on the neck and upper chest. However, the risk of scarring with treatments off the face is reduced by use of lower fluences, and to our knowledge fractional CO₂ laser treatment has not been associated with hypopigmentation," Dr. Ozog says.