National expert consensus on the clinical application of eschar dermabrasion in burn wounds (2021 version) / 中华烧伤杂志

As one of the three major debridement procedures in burn surgery, eschar dermabrasion is optimal to manage fresh deep partial-thickness burn wounds. Despite decades' application in clinic, considerable discrepancies exist in various units on the timing, instruments, procedures, selection of post-operative dressings, and patterns of post-operative dressing change, etc., leading to inconsistent clinical outcomes. After thorough review of relative literature, screening and analysis of high-level evidence articles and multiple in-depth discussions, the expert team of Chinese Burn Association has formed an instructional expert consensus, hoping to provide scientific and standardized guidance for application of eschar dermabrasion in burn wounds.

Healing effects of natural latex serum 1% from Hevea brasiliensis in an experimental skin abrasion wound model

Abstract Background Dermabrasion is related with mechanical and surgical traumas on the skin; usually topical antiseptics and/or saline have been used for healing. Natural products for wound healing can also be used for abrasions, such as latex from Hevea brasiliensis. Objective This study aimed to evaluate the in vitro viability and migratory/proliferative effects of latex serum from H. brasiliensis and to compare with a commercially available standard antiseptic solution and saline in experimental dermabrasion on rats. Methods For in vitro evaluation, MTT and scratch assays were used. In vivo testing was performed in 72 rats submitted to dermabrasion, treated with saline, antiseptic, or latex serum. This study evaluated re-epithelialization, neutrophilic infiltration, and the quantification of crust and epidermis. Results Latex showed viability at 1% and 0.1% concentrations and migratory/proliferative activity at 0.01% concentrations. The re-epithelialization was highest in latex group on 7th day. The latex group displayed lower thickness of crusts and greater extent of epidermal layers. The latex and antiseptic groups showed increases of myeloperoxidase levels on the 2nd day and showed important reductions from the 7th day. Study limitations Acute superficial wound model in rats and non-use of gel-cream (medium) without latex. Conclusion In conclusion, non-toxic latex stimulated migration/proliferation of keratinocytes in vitro and significantly accelerated wound healing in animal excoriation models compared to chlorhexidine or saline.

The diathermy scratch pad: A cheap and efficient tool for chemical and explosion-related burns

The burn center in our hospital is a national and regional (Southeast Asia) center. Of all admissions, 10% are related to blast explosions, and 8% due to chemical burns. In the acute burn management protocol of Singapore General Hospital, early surgical debridement is advocated for all acute partial-thickness burns. The aim of early surgical debridement is to remove all debris and unhealthy tissue, preventing wound infection and thereby expediting wound healing. In chemical burns, there can be stubborn eschars that are resistant to traditional debridement. We would like to present a novel technique using the diathermy scratch pad as a cheap and efficient tool for the dual purpose of surgical debridement and dermabrasion.

Pesquisa de opinião sobre eficácia, custos e cicatrização de procedimentos de resurfacing para rugas estáticas faciais / Expert survey on the efficacy, costs and healing of resurfacing procedures for facial static wrinkles

Foi realizada uma pesquisa de opinião entre especialistas em "resurfacing" cutâneo com a finalidade de compararem-se custos e benefícios entre as técnicas de laser de CO2 totalmente ablativo, lasers fracionados ablativos, lasers fracionados não ablativos, radiofrequência fracionada ablativa, microagulhamento, dermabrasão, peelings médios e peelings de fenol- -óleo de cróton. A opção mais eficaz para tratamento de rugas estáticas faciais foi peeling de fenol-óleo de cróton, ranqueado em primeiro lugar por 71,4% dos experts, seguido de laser de CO2 totalmente ablativo, por 28,6%. Sobre "downtime", os procedimentos elencados com recuperação mais rápida foram microagulhamento e laser fracionado não ablativo, com 42,9% cada um, seguidos por radiofrequência fracionada ablativa, com 14,3%. O período para recuperação completa dos efeitos colaterais e adversos foi percebido como mais curto no microagulhamento por 50% dos experts. Sobre os custos operacionais, o procedimento menos custoso foram peelings médios, de acordo com a opinião de 71,4% dos especialistas. Tais resultados apontam para melhor custo/benefício de procedimentos como peelings químicos e microagulhamento, de acordo com a opinião dos 14 especialistas brasileiros que responderam ao questionário.

A survey on the opinion of specialists regarding skin resurfacing was performed, with the objective of comparing costs and benefits between the techniques: totally ablative CO2 laser, fractional ablative lasers, fractional non-ablative lasers, ablative fractional radiofrequency, microneedling, dermabrasion, medium peels, phenol-croton oil peels. The most effective option for the treatment of static wrinkles was the phenol-croton oil peel, in first place by 71.4% of the experts, followed by totally ablative CO2 laser, by 28.6%. Regarding downtime, procedures ranked as fastest recovery were microneedling and fractional non-ablative lasers, with 42.9% each, followed by ablative fractional radiofrequency, with 14.3%. Complete recovery period for side and adverse effects was perceived as shorter with microneedling by 50% of the experts. Regarding operating costs. The less costly procedure was medium peels, according to the opinion of 71.4% of the experts. Such results point towards a better cost/benefit of procedures such as chemical peels and micro-needling, according to the opinion of 14 Brazilian specialists who answered the questionnaire.

Tratamiento de las arrugas peribucales / Treatment of oral wrinkles

Las arrugas peribucales son tal vez de las más inestéticas de la cara. Los pacientes toleran las frontales, las patas de gallo, los surcos pero no el código de barras, ya que estas son las que más nos avejentan. A través de los años se ha propuesto un sinnúmero de tratamientos, como pulido peribucal, peeling con fenol o tricloroacético, láser y más recientemente rellenos con ácido hialurónico. El fototipo del paciente suele hacernos elegir por un tratamiento u otro, ya que cuanto más oscura la piel del paciente, mayor la probabilidad de pigmentación, tanto con dermoabrasión, fenol o láser. Los rellenos de ácido hialurónico son una muy buena herramienta para cualquier tipo de piel y no dejan el clásico eritema de los otros tratamientos, a veces por hasta 30 días. El hialurónico puede combinarse con peelings mas suaves como el tricloroacético al 15 o 30%. La duración del hialurónico en las arrugas peribucales es de hasta 2 años, a diferencia del año que dura el mismo producto en los surcos nasogenianos. Hay que tener cuidado con la elección del producto y su colocación, porque los cordones, al aplicarlo muy superfi cial o el efecto Tyndall duran mucho tiempo. El índice de complicaciones es mucho menor con el hialurónico y sin los riesgos de discromías, hiperpigmentación o la alteración en la textura de la piel que observamos tantas veces con la dermoabrasión.

Peribucal wrinkles are perhaps the most unfl attering of the face. Patients tolerate the frontal wrinkles, crow's feet and grooves but not the bar code, since these are the ones that make them feel older. Over the years, a number of treatments have been proposed, such as peribucal polishing, peeling with phenol or trichloroacetic, laser and more recently fi lled with hyaluronic acid. The phototype of the patient usually makes us choose one treatment or another, since the darker the skin, the greater the chance of pigmentation, either with dermabrasion, phenol or laser. The hyaluronic acid fi llers are a very good tool for any type of skin and do not leave the classic erythema of the other treatments, sometimes lasting for up to 30 days. The hyaluronic acid fi ller can be combined with softer peels such as trichloroacetic at 15 or 30%. The duration of the fi ller in peribucal wrinkles is up to 2 years, unlike the year duration of the same product in the nasogenian furrows. You have to be careful with the choice of the product and its placement, because of the apperence of cords, when applied very superfi cial or the Tyndall eff ect that can last a long time. The rate of complications is much lower with hyaluronic acid and without the risks of dyschromia, hyperpigmentation or the alteration in skin texture observed so often with dermabrasion.

Dermoabrasión como alternativa de tratamiento en quemaduras tipo AB en pacientes pediátricos. Experiencia del Servicio de Cirugía Plástica, Unidad de Quemados del Hospital Pediátrico Fernando Bareyro / Dermoabrasion for treatment in pediatric burns

La dermoabrasión en combinación con sulfadiazina de plata y lidocaína, como tratamiento para las quemaduras AB en pacientes pediátricos, presenta ventajas en cuanto a los resultados que ofrece, ya que es un método sencillo y reproducible. Como desventaja presenta que se requieren varias sesiones de tratamiento y en algunos casos, donde se produjo profundización de la lesión, se requirió cobertura con injerto de pie

Clinical Consideration about Characteristics and Treatment of Scalding Burn Caused by Instant Noodle

PURPOSE: Instant noodle is one of the most popular noodle and its consumption is increasing annually. So scalding burns caused by Instant noodle are comparatively common. Instant noodle can lead to contact burn caused by noodle as well as scalding burn by soup. Because the depth of the burn can be deeper than general scalding burn, it can cause physical or psychological disability and the medical and social expense is not a few. The purpose of this study was to investigate the epidemiology and clinical features of the scalding burn caused by Instant noodle. METHODS: Retrospective research was conducted 165 patients with scalding burn by Instant noodle among patients admitted to our burn medical center from May 2011 to April 2016. Subjects were classified by age, gender, affected site and degree and treatment method. RESULTS: For 6 years, 165 subjects went through hospital treatment because of the scalding burn by Instant noodle. It consisted of 48 infants, 74 children and adolescence, and 43 adults. The average TBSA (total body surface area, %) was 3.43. The number of patients exceeding 10% were 3. The most common affected site was thigh in 35.5% and there was no big differences between each age group. 8 patients did operations and 6 did dermabrasion. CONCLUSION: From May 2011 to April 2016, about 7% of total scalding burn patients was injured by Instant noodle. Considering the characteristics of scalding burn by Instant noodle, conservative treatment was preferred to surgical treatment. 149 of total 165 patients were done conservative treatment using cultured allogenic keratinocytes.

365 nm LED laser treatment on beagle for gingival whitening without gum dermabrasion

PURPOSE: Gingival whitening is one of dental treatment purposes which is close to treating aesthetic disorders. Initial gingival whitening treatment was done by dermabrasion using a high power Diode Laser. However, this treatment method cannot be free from any infection or pain after the treatment. Therefore, we have decided to progress gingival whitening treatment using a low power LED laser. MATERIALS AND METHODS: The laser was irradiated on pork meat then the safety of output power, temperature change and skin denaturalization was measured. Bison 365 nm LED laser was irradiated on oral mucosal pigment of a 15 - 20 kg beagle for 15 min for 1 - 2 weeks, one or two times each. Any pigment loss was checked through Hematoxyline-Eosin staining. RESULTS: The melanin pigments at the area of 365 nm LED Laser irradiation were decreased. CONCLUSION: The 365 nm LED Laser proposed in this study is considered to compensate the bleaching effect achieved by either using Diode laser or surgical methods.

Effect of Dermabrasion and ReCellon Large Superficial Facial Scars Caused by Burn, Trauma and Acnes / 中国医学科学杂志(英文版)

<strong>Objective</strong> To explore the effects of dermabrasion combined with ReCellon large superficial facial scars caused by burn, trauma and acnes.<strong>Methods</strong> Nineteen patients with large superficial facial scars were treated by the same surgeon with dermabrasion combined with ReCell. According to the etiology, patients were classified into post-burning group (n=5), post-traumatic group (n=7) and post-acne group (n=7). Fifteen patients completed the follow-ups, 5 patients in each group. Healing time, complication rate, the preoperative and 18-month-post-operative assessments using Patient Satisfaction Score (PSS), Vancouver Scar Scale (VSS), and Patient and Observer Scar Assessment Scale (POSAS) of each group were analyzed to compare the effect of the combined therapy on outcomes.<strong>Results</strong> The healing time of post-burning group (19.6±4.0 days), post-traumatic group (15.8±2.6 days), and post-acne group (11.4±3.1 days) varied remarkably (F=7.701, P=0.007). The complication rates were 60%, 20%, and 0 respectively. The post-operative POSAS improved significantly in all groups (P<0.05), where the most significant improvement was shown in the post-acne group (P<0.05). The post-operative PSS and VSS improved only in the post-traumatic group and post-acne group (all P<0.05), where the more significant improvement was also shown in the post-acne group (P<0.05).<strong>Conclusions</strong> The combined treatment of dermabrasion and ReCellhas remarkable effect on acne scars, moderate effect on traumatic scars and is not suggested for burn scars. POSAS should be applied to assess the therapeutic effects of treatments for large irregular scars.

A Case of Refractory Vitiligo That Was Treated with a Combination of Non-ablative 1550-nm Erbium:Glass Fractional Laser, Narrow-band UVB, and a Topical Agent / 대한피부과학회지

There are many therapeutic methods for treating vitiligo, including narrow-band UVB, topical corticosteroids, calcineurin inhibitors, excimer laser, and surgical methods, such as autologous epidermal grafting and dermabrasion. However, although various treatments have been tried, there is still no reliable treatment. Recently, there were several reports about the use of fractional laser combined with narrow-band (NB) UVB to treat vitiligo. A 33-year-old male patient presented with hypopigmented patch on lower right abdominal area. After being diagnosed with vitiligo, the patient underwent NB-UVB treatment and application of a topical agent for two years but failed to show response. To evaluate the efficacy of non-ablative fractional laser, a 1550-nm erbium:glass (Er:Glass) fractional laser was applied to whole area of the lesion. The area showed erythema and brown microscopic epidermal necrotic debris. Five days after the laser procedure, NB-UVB treatment with application of a topical agent was initiated once or twice a week, followed by pigmentation of the treated area . The fractional laser was reapplied three months later, and the patient is currently under observation and is still being treated with NB-UVB. We observed successful treatment of refractory vitiligo with the combination of non-ablative 1550-nm Er:Glass fractional laser, NB-UVB, and a topical agent. We consider non-ablative Er:Glass fractional laser as a favorable choice of treatment for refractory vitiligo.

Una puesta al día en el tratamiento de las queratosis actínicas / An update on the treatment of actinic keratosis

Las queratosis actínicas son una de las causas más frecuentes de consultas dermatológicas. Están consideradas como lesiones premalignas que pueden evolucionar a carcinoma espinocelular invasor. Constituyen un marcador de fotodaño y actualmente se consideran como modelo de cancerización de campo. Existen diversos tipos de tratamientos que se clasifican en terapias dirigidas a la remoción de la lesión (crioterapia y / o quirúrgicos) y terapias dirigidas al campo de cancerización que incluyen: inmunomoduladores tópicos (imiquimod y diclofenaco), agentes quimioterapéuticos (5-Fluorouracilo y retinoides), Ingenol mebutato, dermoabrasión, peelings químicos, láser, terapia fotodinámica y terapias combinadas entre otras. El principal objetivo de esta revisión es realizar una actualización de las terapias dirigidas al campo de cancerización de las queratosis actínicas con sus respectivas indicaciones, ventajas y desventajas.

Actinic keratosis are one of the most common causes of dermatological consultation. Considered as premalignant lesions that can progress to invasive squamous cell carcinoma. Constitute a marker of photodamage and actually considered as a model of field cancerization. There are several types of treatments classified as therapies targeting the removal of the lesion (cryotherapy and / or surgery) and targeted therapies of field cancerization that include topical immunomodulators (imiquimod and diclofenac), chemotherapeutic agents (5-fluorouracil, and retinoids), ingenol mebutate, dermabrasion, chemical peels, laser, photodynamic therapy and combination therapies among others. The main objective of this review is to update therapies of field cancerization for actinic keratosis with their respective indications, advantages and disadvantages.

A novel treatment for facial acne scars: dermabrasion combined with Recell® (skin active cell transplantation) technique / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and risksof the treatment of facial acne scar with dermabrasion combined with Recell® technology.</p><p><b>METHODS</b>30 patents with II or III degree facial acne scars were treated with dermabrasion and Recell® (skin active cell transplantation) technique in our department from October 2010 to October 2011. The affected area in the face was dermabraded with micro motor system. Then a small piece of razor-thickness skin graft was obtained and processed with Recell® kit. Several milliliterof autologous uncultured epidermal cell suspension was applied to the facial wound and covered with appropriate dressings.</p><p><b>RESULTS</b>Theeffectiveness and risks of this treatment was evaluated with regard to wound healing time, postoperative complication rate, erythema period, etc. Wound healing time was shortened to 5-7 days. The erythema period was also observed shortened with this technique. Within the follow up period, no hyperpigmentation was reported in this case serial.</p><p><b>CONCLUSION</b>Dermabrasion combined with Recell® (skin active cell transplantation) technology can provide a safety and effective treatment approach for patients with facial acne scars.</p>

The Clinical Efficacy of Early Dermabrasion and Frozen Cultured Allogenic Keratinocyte in Management of the Deep Second Degree Burn with Thin Eschar

PURPOSE: As in the case of the deep second-degree burn, proper eschar elimination and early epithelization is essential for spontaneous healing without surgical intervention. Accordingly, we have treated with using early dermabrasion and appling frozen cultured allogenic keratinocyte patients in deep second degree burns an eschar formed. METHODS: From January 2011 to January 2012 at Kepco medical center, we selected 46 patients who were suffered from deep second degree burn formed an eschar were enrolled. Patients were divided into two parts, study and control group. Study group were performed dermabrasion within first 3 days to 10 days of the injury and then applied frozen cultured allogenic keratinocyte. control group were managed moist dressing using hydrocolloid gel, form and alginate materials. We tried to prove its clinical efficacy by researching the period of wound healing, percentage of skin graft, and hospital days under chart review and photograph. RESULTS: In study group, the mean period of wound healing was 15.13+/-4.18 (mean+/-S.D.) days, and that of the hospitalization was 16.65+/-5.31 (mean+/-S.D.) days. For the 3 patients without the epithelization, skin graft was conducted. As for the control group, the mean period of wound healing was 24.22+/-2.79 (mean+/-S.D.) days, and that of the hospitalization was 28.30+/-3.33 (mean+/-S.D). 21 patients were conducted skin grafts. CONCLUSION: Based on these results, we concluded that the treatment in deep second degree burn patients eschar formed using early dermabrasion and frozen cultured allogenic keratinocyte is effective in reducing the duration of period of wound healing, hospital day and rate of skin graft.

Multiple Trichoepithelioma Improved by Intralesional Bleomycin Injection / 대한피부과학회지

Multiple trichoepithelioma is a benign adnexal neoplasm characterized by the presence of many small papules that appear predominantly on the face. Clinical improvement have been demonstrated after several treatments such as carbon dioxide laser, cryotherapy, dermabrasion, and argon laser. However, these destructive methods have various disadvantages. We report a case of multiple trichoepithelioma treated with an intralesional bleomycin injection. Fewer lesions without scars and cosmetic improvements were observed. Bleomycin is a cytotoxic antitumor antibiotic that can be injected intralesionally by transcutaneous administration and displays excellent results for treating malignancies including skin tumors. We believe that intralesional bleomycin injection is an effective treatment option for this condition, and an easy method to conduct at the outpatient clinic.

Melasma: patogénesis y tratamiento / Melasma: pathogenesis and treatment

El melasma es un desorden pigmentario simétrico que afecta áreas fotoexpuestas de mujeres, y que también ha sido descrito en hombres. Esto hiperpigmentación es inducido, principalmente por lo radiación ultravioleta y por factores hormonales, entre otros. Su patogénesis no es del todo conocido y su tratamiento a la fecha es difícil. La mayoría de los agentes despigmentontes actúan o diferentes niveles de la biosíntesis de lo melanina y de su transferencia al queratinocito. Éstos agentes pueden asociarse entre sí, o utilizarse por si solo. Las terapias físicas como el tratamiento químico abrasivo, la dermabrasión y el láser también han sido descritas.

Melasma is an acquired symmetrical pigmentary disorder that affects sun-exposed skin in females, but is also present in men. The hyperpigmentation is mostly induced by ultraviolet radiation and hormones among others. The pathogenesis remains largely unknown and treatment is still nowadays difficult. Most of the lightening agents acts at different levels of the biosynthesis of melanin and its transfer to keratinocytes. These agents may be used alone or in combination between them. Physical therapy, such as peeling. dermabrasion and laser, have also been described.

Queratodermias palmoplantares adquiridas: revisión bibliográfica / Acquired palmoplantar keratoderma: bibliographic review

Las queratodermias palmo plantares son un grupo diverso de trastornos caracterizados por el engrosamiento anormal de la piel de las palmas y pantas, que puede ser hereditario o adquirido. Este últimos se define como una hiperqueratosis no hereditaria, no friccionar, de las palmas y/o las plantas que afecta al 50% o más de estas superficies ocrales. Es un trastorno de múltiples etiologías, entre las cuales destacan: el climaterio, asociada a malignidad, a otras dermatosis, acuagénica, causada por infecciones, asociada a medicamentos, a enfermedades sistémicas, y la hiperqueratosis palmo plantar filiforme (queratodemia espinosa). El tratamiento tiende a ser sintomático y puede variar desde medidas simples a queratoliticos tópicos, retinoides sistémicos o cirugía reconstructiva. En algunas queratodermias especificas, como la climatérica y aquellas asociadas a hipotiroidismo, el tratamiento indicado es el reemplazo hormonal, y en las asociadas a malignidad, la extirpación del tumor habitualmente produce la mejoría de to hiperqueratosis.

Palmoplantar keratodermas are a diverse group of disorders characterized by an abnormal thickening of the skin of the palms and soles, which can be hereditary or acquired. The last form above mentioned is defined as a non-hereditary, non-frictional hyperkeratosis of the palms and/or soles that involves 50 percent or more of the surface of these acral areas. This is a disorder produced by multiple causes, among which highlight climacteric, associated with malignancies, related with another dermatoses, aquagenic, infectious, drug-related, related with systemic disease and palmar/plantar filiform hyperkeratosis (spiny keratoderma). Treatment tends to be symptomatic and may vary from simple advices to topical keratolytics, systemic retinoids or reconstructive surgery. In some specific keratodermas like the climacteric one and in those associated with hypothyroidism the recommended treatment corresponds to hormonal replacement and in those associated with malignancies the removal of the tumor usually results in improvement of the hyperkeratosis.

A Combination of Dual-mode 2,940 nm Er:YAG Laser Ablation with Surgical Excision for Treating Medium-sized Congenital Melanocytic Nevus

BACKGROUND: There are various treatment options for congenital melanocytic nevus (CMN), including surgical excision, dermabrasions, curettage, laser treatment, chemical peels and cryosurgery. The proper choice of treatment depends on the size, location, thickness and clinical appearance of the nevi, the risk for developing melanoma, the psychological effect and the cosmetic component. OBJECTIVE: The purpose of this study is to evaluate the outcome of a combination of surgical excision with Er: YAG laser ablation for treating CMNs. METHODS: A total of 13 patients were included in this study. The nevus was excised as much as possible and only dermal suturing was performed, without epidermal suturing, for the primary closure. We then ablated the whole lesion, including the suture lines, by using a dual-mode 2,940 nm Er:YAG laser with three to five passes. All the lesions were followed up for 6 months and they were evaluated with respect to the healing status, infection, erythema, scarring, textural change and pigmentary change. Subject satisfaction was scored at the 16th week by the patients. RESULTS: Eleven (83%) of the 13 patients were clinically rated as having a good to excellent result by the physicians' Global Assessment Scale (GAS) scores for the lesions' reduction of size, the degree of scarring and the pigmentary change with only a one stage procedure. 10 (77%) of the total 13 patients reported a good to excellent result at four months after treatment. CONCLUSION: A combination of surgical excision with Er:YAG laser ablation as a one stage procedure is a safe, effective modality and it should be considered as one of the options for treating medium-sized CMNs.

A Combination of Dual-mode 2,940 nm Er:YAG Laser Ablation with Surgical Excision for Treating Medium-sized Congenital Melanocytic Nevus

BACKGROUND: There are various treatment options for congenital melanocytic nevus (CMN), including surgical excision, dermabrasions, curettage, laser treatment, chemical peels and cryosurgery. The proper choice of treatment depends on the size, location, thickness and clinical appearance of the nevi, the risk for developing melanoma, the psychological effect and the cosmetic component. OBJECTIVE: The purpose of this study is to evaluate the outcome of a combination of surgical excision with Er: YAG laser ablation for treating CMNs. METHODS: A total of 13 patients were included in this study. The nevus was excised as much as possible and only dermal suturing was performed, without epidermal suturing, for the primary closure. We then ablated the whole lesion, including the suture lines, by using a dual-mode 2,940 nm Er:YAG laser with three to five passes. All the lesions were followed up for 6 months and they were evaluated with respect to the healing status, infection, erythema, scarring, textural change and pigmentary change. Subject satisfaction was scored at the 16th week by the patients. RESULTS: Eleven (83%) of the 13 patients were clinically rated as having a good to excellent result by the physicians' Global Assessment Scale (GAS) scores for the lesions' reduction of size, the degree of scarring and the pigmentary change with only a one stage procedure. 10 (77%) of the total 13 patients reported a good to excellent result at four months after treatment. CONCLUSION: A combination of surgical excision with Er:YAG laser ablation as a one stage procedure is a safe, effective modality and it should be considered as one of the options for treating medium-sized CMNs.