Pitfalls and recommendations in cases of laser removal of decorative tattoos with pigmented lesions: case report and review of the literature.

IMPORTANCE: Pigmented lesions in decorative tattoos cause diagnostic difficulties at a clinical and dermoscopic level. In cases of laser removal of tattoos, hidden suspicious nevi may be revealed gradually. OBSERVATIONS: We describe the first case of a malignant melanoma that developed on a preexisting nevus within a tattoo during and between the phases of laser removal. The patient refused to undergo excision of the nevus until we made excision conditional for continued laser treatment. CONCLUSIONS AND RELEVANCE: The English literature reports 16 cases of malignant melanoma developing in tattoos. Correlation between the placement of tattoos and the development of malignant melanoma remains unclear. Our case emphasizes the diagnostic problems of pigmented lesions within tattoos. For safety reasons, tattoos should never be placed on pigmented lesions; if they are, the tattoos should not undergo laser treatment. We suggest an excision before starting laser tattoo removal. Dermoscopic assessments on a regular basis during the period of tattoo removal are recommended.

Treatment errors resulting from use of lasers and IPL by medical laypersons: results of a nationwide survey.

BACKGROUND: The demand for hair and tattoo removal with laser and IPL technology (intense pulsed light technology) is continually increasing. Nowadays these treatments are often carried out by medical laypersons without medical supervision in franchise companies, wellness facilities, cosmetic institutes and hair or tattoo studios. This is the first survey is to document and discuss this issue and its effects on public health. PATIENTS AND METHODS: Fifty patients affected by treatment errors caused by medical laypersons with laser and IPL applications were evaluated in this retrospective study. We used a standardized questionnaire with accompanying photographic documentation. Among the reports there were some missing or no longer traceable parameters, which is why 7 cases could not be evaluated. RESULTS: The following complications occurred, with possible multiple answers: 81.4% pigmentation changes, 25.6% scars, 14% textural changes and 4.6% incorrect information. The sources of error (multiple answers possible) were the following: 62.8% excessively high energy, 39.5% wrong device for the indication, 20.9% treatment of patients with darker skin or marked tanning, 7% no cooling, and 4.6% incorrect information. CONCLUSIONS: The causes of malpractice suggest insufficient training, inadequate diagnostic abilities, and promising unrealistic results. Direct supervision by a medical specialist, comprehensive experience in laser therapy, and compliance with quality guidelines are prerequisites for safe laser and IPL treatments. Legal measures to make such changes mandatory are urgently needed.

Pyogenic granuloma: treatment with the 1,064-nm long-pulsed neodymium-doped yttrium aluminum garnet laser in 20 patients.

BACKGROUND: There are various therapeutic options for the treatment of pyogenic granuloma (PyG), but the results are frequently unsatisfactory, especially at difficult sites and with extensive lesions. OBJECTIVE: To evaluate the success of treatment of PyG using the 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and to compare it with state-of-the-art treatment methods. MATERIALS AND METHODS: Twenty patients with PyG were treated using the long-pulsed 1,064-nm Nd:YAG laser with fluences of 60 to 180 J/cm(2) , a spot size of 7 mm, and a pulse duration of 40 ms. One to four treatment sessions were necessary for complete removal. RESULTS: Recurrence-free healing occurred in 19 of 20 patients (follow-up ≥ 6 months, maximum 22 months). Because of heavy bleeding, one nonresponder was successfully treated using a carbon dioxide laser. The cosmetic results were good; textural changes of the skin were slight, if present at all. CONCLUSION: When used with the right strategy and patient cohort, the long-pulse 1,064-nm Nd:YAG laser is an effective, low-risk, minimally invasive method of treating PyG. This type of laser is a good therapeutic option that achieves good cosmetic results, particularly in PyG with a large diameter that are not suitable for treatment using the pulsed dye laser.