The use of the 1.0 mm handpiece in high energy, pulsed CO2 laser destruction of facial adnexal tumors.

BACKGROUND: The treatment of syringoma and trichoepithelioma has included punch and shave biopsy, excision, electrodessication, as well as continuous wave and superpulsed carbon dioxide laser ablation. More recently, high-energy pulsed CO2 lasers have been reported to be effective with standard available handpieces that deliver collimated beams.

OBJECTIVE: To report our experience using a focusing handpiece (1.0 mm spot at focus) with a high energy pulsed CO2 laser.

METHODS: Four patients with syringoma and two with multiple trichoepithelioma were treated with a high energy pulsed CO2 laser using a 1 mm spot size focusing handpiece. Pulse energies ranged from 125 to 250 mJ. All patients were followed 2 weeks after treatment and then for variable periods ranging from 8 to 18 months (mean=13.3 months).

RESULTS: The 1 mm spot focusing handpiece permitted rapid tumor ablation with optimal matching of lesion size and laser spot diameter. Recurrence of tumor was associated with superficial ablation while complications such as hypopigmentation and atrophy were associated with deeper ablation.

CONCLUSION: Facial adnexal tumors such as syringoma and trichoepithelioma can be successfully treated with the 1.0 mm handpiece in tandem with high energy pulsed CO2 lasers.