Treatment of perioral rhytides: a comparison of dermabrasion and superpulsed carbon dioxide laser.

OBJECTIVE: To directly compare the cosmetic outcome and adverse effects of dermabrasion and superpulsed carbon dioxide laser for the treatment of perioral rhytides. DESIGN: Subjects were randomly assigned to receive treatment with carbon dioxide laser resurfacing to one side of the perioral area and dermabrasion to the other side in a prospective, comparative clinical study. The duration of follow-up by blinded observers was 4 months. SETTING: University hospital-based dermatologic surgery clinic. PATIENTS: Fifteen healthy fair-skinned volunteers with moderate to severe perioral rhytides and no history of prior cosmetic surgical procedures to the same anatomic area. INTERVENTIONS: One half of the perioral area was treated with the LX-20SP Novapulse carbon dioxide laser (Luxar Corp, Bothell, Wash), and the other half was treated with dermabrasion using either a hand engine-driven diamond fraise or a medium-grade drywall sanding screen (3M Corp, St Paul, Minn). MAIN OUTCOME MEASURES: Improvement in rhytides, patients' subjective reports of postoperative pain, time to reepithelialization, degree of postoperative crusting, and duration of postoperative erythema were observed for both methods. Standardized scoring systems were used to quantify outcome measures. Paired t tests were used for statistical comparisons of the 2 resurfacing methods. RESULTS: The difference in rhytide scores for the 2 methods was not statistically significant (P= .35) at 4 months. Less postoperative crusting and more rapid reepithelialization were noted with the dermabrasion-treated skin. Postoperative erythema was of longer duration on laser-treated skin. Patients reported less pain with dermabrasion treatment. Subtle differences that were difficult to quantify were also noted between the methods. CONCLUSIONS: Both dermabrasion and carbon dioxide laser resurfacing are effective in the treatment of perioral rhytides. Both methods have unique advantages and disadvantages.

Incidence of residual basal cell carcinoma in patients who appear tumor free after biopsy.

BACKGROUND: Basal cell carcinoma (BCC) biopsy sites often heal with no clinical evidence of residual tumor. OBJECTIVE: The purpose of our study is to determine whether such patients require further therapy. If biopsies can be curative, health care costs can be reduced by avoiding unnecessary surgery. METHODS: We prospectively evaluated 41 consecutive subjects with 42 biopsy-confirmed BCCs who appeared disease free. Each biopsy site was excised and processed by the Mohs micrographic technique. The tissue block was sectioned horizontally at 30-micrometer intervals until exhausted. Sections were stained and examined microscopically for residual tumor. RESULTS: Tumor was identified in 28 (66%) of 42 cases. No statistically significant relationship was found between the presence or absence of residual tumor and the following variables: age, sex, tumor location, biopsy technique, histopathologic subtype, scar size, time from biopsy to surgery, and extent of inflammation in histologic sections. CONCLUSION: Our data suggest that patients with small (< 1 cm) primary BCCs that appear to be completely removed after a biopsy procedure are at risk for recurrence without further treatment.

Squamous cell carcinoma of the lip treated with Mohs micrographic surgery: outcome at 5 years.

BACKGROUND: Mohs micrographic surgery (MMS) is believed to be a highly effective treatment of squamous cell carcinoma (SCC) of the lip. OBJECTIVE: The goals of our study were to determine the long-term (5-year) outcome of patients treated with MMS for SCC of the lip and to identify factors associated with tumor recurrence. METHODS: Clinical and histopathologic data from 50 consecutive cases of SCC of the lip treated with MMS were retrospectively reviewed. RESULTS: There were no tumor-related deaths or metastases. Forty-six patients (92%) remained free of disease. Four patients (8%) were diagnosed with SCC at the surgical site after MMS. Recurrent lesions tended to be superficial and occurred in the setting of severe actinic cheilitis. The average time to diagnosis after MMS was 2.5 years. All patients with recurrent disease were treated with further MMS and had successful results. No recurrences were seen among patients who received adjuvant treatment for actinic cheilitis with the carbon dioxide (CO2) laser, had clinical lesions 1 cm or less in diameter, or had post-MMS defects 2 cm or less in diameter. CONCLUSION: MMS is highly effective for treating both primary and recurrent SCC of the lip. Treatment of coexisting actinic cheilitis may lower the risk for local recurrence after MMS.