Department of Dermatovenereology, Charles University, Faculty of Medicine and Teaching Hospital in Pilsen, Czech Republic.
J Dtsch Dermatol Ges. 2019 Apr;17(4):425-431. doi: 10.1111/ddg.13814. Epub 2019 Apr 1.
Lentigo maligna is a common in situ malignancy in elderly patients, with a low risk of progression to an invasive tumor. Surgical treatment may be complicated or refused. Non-surgical treatment options (such as lasers) may therefore be needed.
We report on 17 patients treated with a 2940-nm Er:YAG (erbium-doped yttrium aluminum) laser for histopathologically confirmed lentigo maligna. The lesions were ablated with a 5 mm margin of adjacent skin under local anesthesia with a 3.5 mm overlapping spot, energy density of 6.5 J/cm and a repetition rate of 5 Hz. If clinically visible pigmentation was seen in the ablated area during the following three months, the lesion was re-treated. All patients were followed up for residual or recurrent tumors.
We achieved clinical clearance in all 17 patients. There were three recurrences during the follow-up period (9, 30 and 36 months after laser therapy). All patients were satisfied with the treatment course and cosmetic outcome. The mean follow-up duration was 28 months.
Laser ablation is an interesting alternative method for treatment of lentigo maligna. It can be used for selected cases where surgery is contraindicated, complicated or declined by the patient.
恶性雀斑样痣是一种常见的老年患者原位恶性肿瘤，进展为侵袭性肿瘤的风险较低。手术治疗可能会很复杂或被拒绝。因此，可能需要非手术治疗选择（如激光）。
我们报告了 17 例经 2940nmEr:YAG（掺铒钇铝石榴石）激光治疗的病理证实为恶性雀斑样痣患者。在局部麻醉下，用 5mm 边缘的相邻皮肤切除病变，重叠光斑 3.5mm，能量密度 6.5J/cm，重复率 5Hz。如果在接下来的三个月中在切除区域看到临床可见的色素沉着，则对病变进行再次治疗。所有患者均随访残留或复发肿瘤。
我们在所有 17 例患者中均达到了临床清除。在激光治疗后 9、30 和 36 个月，有 3 例复发。所有患者均对治疗过程和美容效果满意。平均随访时间为 28 个月。
激光消融是治疗恶性雀斑样痣的一种有趣的替代方法。它可用于手术禁忌、复杂或患者拒绝手术的选定病例。
