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Laser Revision and Rehabilitation of Mohs Micrographic Surgical Scars

  • Laser Therapy (J Jagdeo, Section Editor)
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Abstract

The use of Mohs micrographic surgery has become standard of care to treat a multitude of skin cancers to ensure tissue preservation. However, with any skin surgery, a cutaneous scar is the byproduct, and thus, laser scar revision has become mainstay of treatment. By utilizing varying laser wavelengths, different components that make up a particular scar can be targeted. Lasers are being used to improve scar texture, vascularity, pigmentation, and thickness, and it is important to understand the different uses and applications. Herein, we will review current practices for utilizing lasers or combination treatments to improve post Mohs surgery scars.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. Rogers HW, Weinstock MA, Harris AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol. 2010;146(3):283–7.

    Article  PubMed  Google Scholar 

  2. Connolly SM, Baker DR, Coldiron BM, et al. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. J Am Acad Dermatol. 2012;67(4):531–50.

    Article  PubMed  Google Scholar 

  3. Kaeb S, Landthaler M, Hohenleutner U. Confocal laser scanning microscopy—evaluation of native tissue sections in micrographic surgery. Lasers Med Sci. 2009;24(5):819–23.

    Article  PubMed  Google Scholar 

  4. FE M. Chemosurgery: microscopically controlled surgery for skin cancer. Springfield, IL: Charles C Thomas; 1978.

    Google Scholar 

  5. Mikhail GRM. Frederic Edward Mohs micrographic surgery. Philadelphia: W.B. Saunders; 1991.

    Google Scholar 

  6. Rowe DE, Carroll RJ, Day Jr CL. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol. 1989;15(3):315–28.

    Article  CAS  PubMed  Google Scholar 

  7. Rowe DE, Carroll RJ, Day Jr CL. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol. 1989;15(4):424–31.

    Article  CAS  PubMed  Google Scholar 

  8. Hanke CW, Moy RL, Roenigk RK, et al. Current status of surgery in dermatology. J Am Acad Dermatol. 2013;69(6):972–1001.

    Article  PubMed  Google Scholar 

  9. Dixon AJ, Dixon MP, Dixon JB. Prospective study of long-term patient perceptions of their skin cancer surgery. J Am Acad Dermatol. 2007;57(3):445–53.

    Article  PubMed  Google Scholar 

  10. Sobanko JF, Sarwer DB, Zvargulis Z, Miller CJ. Importance of physical appearance in patients with skin cancer. Dermatol Surg. 2015;41(2):183–8. This article denotes that scars, especially on the head and neck region, can negatively impact a patient’s psychosocial functioning.

    Article  CAS  PubMed  Google Scholar 

  11. Cassileth BR, Lusk EJ, Tenaglia AN. Patients’ perceptions of the cosmetic impact of melanoma resection. Plast Reconstr Surg. 1983;71(1):73–5.

    Article  CAS  PubMed  Google Scholar 

  12. Kasper DA, Cohen JL, Saxena A, Morganroth GS. Fillers for postsurgical depressed scars after skin cancer reconstruction. J Drugs Dermatol. 2008;7(5):486–7.

    PubMed  Google Scholar 

  13. Yarborough Jr JM. Ablation of facial scars by programmed dermabrasion. J Dermatol Surg Oncol. 1988;14(3):292–4.

    Article  PubMed  Google Scholar 

  14. Trisliana Perdanasari A, Lazzeri D, Su W, et al. Recent developments in the use of intralesional injections keloid treatment. Arch Plast Surg. 2014;41(6):620–9. doi:10.5999/aps.2014.41.6.620.

  15. Bleasdale B, Finnegan S, Murray K, Kelly S, Percival SL. The use of silicone adhesives for scar reduction. Adv Wound Care. 2015;4(7):422–30.

    Article  Google Scholar 

  16. Tierney E, Mahmoud BH, Srivastava D, Ozog D, Kouba DJ. Treatment of surgical scars with nonablative fractional laser versus pulsed dye laser: a randomized controlled trial. Dermatol Surg. 2009;35(8):1172–80.

    Article  CAS  PubMed  Google Scholar 

  17. Tanzi EL, Lupton JR, Alster TS. Lasers in dermatology: four decades of progress. J Am Acad Dermatol. 2003;49(1):1–31. quiz 31-34.

    Article  PubMed  Google Scholar 

  18. Goldman L, Blaney DJ, Kindel Jr DJ, Richfield D, Franke EK. Pathology of the effect of the laser beam on the skin. Nature. 1963;197:912–4.

    Article  CAS  PubMed  Google Scholar 

  19. Castro DJ, Abergel RP, Meeker C, Dwyer RM, Lesavoy MA, Uitto J. Effects of the Nd:YAG laser on DNA synthesis and collagen production in human skin fibroblast cultures. Ann Plast Surg. 1983;11(3):214–22.

    Article  CAS  PubMed  Google Scholar 

  20. Alster TS. Improvement of erythematous and hypertrophic scars by the 585-nm flashlamp-pumped pulsed dye laser. Ann Plast Surg. 1994;32(2):186–90.

    Article  CAS  PubMed  Google Scholar 

  21. Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet. 1995;345(8959):1198–200.

    Article  CAS  PubMed  Google Scholar 

  22. Kim DH, Ryu HJ, Choi JE, Ahn HH, Kye YC, Seo SH. A comparison of the scar prevention effect between carbon dioxide fractional laser and pulsed dye laser in surgical scars. Dermatol Surg. 2014;40(9):973–8.

    Article  CAS  PubMed  Google Scholar 

  23. Alster TS, Lupton JR. Are all infrared lasers equally effective in skin rejuvenation. Semin Cutan Med Surg. 2002;21(4):274–9.

    Article  PubMed  Google Scholar 

  24. Kim SG, Kim EY, Kim YJ, Lee SI. The efficacy and safety of ablative fractional resurfacing using a 2,940-Nm Er:YAG laser for traumatic scars in the early posttraumatic period. Arch Plast Surg. 2012;39(3):232–7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Manuskiatti W, Triwongwaranat D, Varothai S, Eimpunth S, Wanitphakdeedecha R. Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians. J Am Acad Dermatol. 2010;63(2):274–83.

    Article  PubMed  Google Scholar 

  26. Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Lasers Surg Med. 2013;45(3):135–40.

    Article  PubMed  Google Scholar 

  27. Sclafani AP, Sclafani JA, Sclafani AM. Successes, revisions, and postoperative complications in 446 Mohs defect repairs. Facial Plast Surg. 2012;28(3):358–65.

    Article  CAS  PubMed  Google Scholar 

  28. Alster TS, Williams CM. Treatment of keloid sternostomy scars with 585 nm flashlamp-pumped laser. Lancet. 1995;345:1198–2000.

    Article  CAS  PubMed  Google Scholar 

  29. Vazquez-Martinez O, Eichelmann K, Carcia-Melendez M, et al. Pulsed dye laser for early treatment of scars after dermatological surgery. J Drugs Dermatol. 2015;14(11):1209–12.

    CAS  PubMed  Google Scholar 

  30. Kono T, Ercocen AR, Nakazawa H, et al. The flashlamp-pumped pulsed dye laser (595 nm) treatment of hypertrophic scars in Asians. Ann Plast Surg. 2003;51(4):366–71.

    Article  PubMed  Google Scholar 

  31. McCraw JB, McCraw JA, Mcmellin A, et al. Prevention of unfavorable scars using early pulse dye laser treatments: a preliminary report. Ann Plast Surg. 1999;42:7–14.

    Article  CAS  PubMed  Google Scholar 

  32. Bellew SG, Weiss MA, Weiss RA. Comparison of intense pulsed light to 595-nm long-pulsed pulsed dye laser for treatment of hypertrophic surgical scars: a pilot study. J Drugs Dermatol. 2005;4(4):448–52.

    PubMed  Google Scholar 

  33. Nouri K, Jiminez GP, Harrison-Balestra C, et al. 585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day. Dermatol Surg. 2003;29:65–73.

    PubMed  Google Scholar 

  34. Ortonne JP, Bissett DL. Latest insights into skin hyperpigmentation. J Investig Dermatol Symp Proc. 2008;13(1):10–4.

    Article  PubMed  Google Scholar 

  35. Bowes LE, Nouri K, Berman B, et al. Treatment of pigmented hypertrophic scars with the 585 nm pulsed dye laser and the 532 nm frequency-doubled Nd:YAG laser in the Q-switched and variable pulse modes: a comparative study. Dermatol Surg. 2002;28:714–9.

    PubMed  Google Scholar 

  36. Dierickx C, Goldman MP, Fitzpatrick RE. Laser treatment of erythematous/hypertrophic and pigmented scars in 26 patients. Plast Reconstr Surg. 1995;95(1):84–90.

    Article  CAS  PubMed  Google Scholar 

  37. Hultman CS, Friedstat JS, Edkins RE. Efficacy of intense pulsed light for the treatment of burn scar dyschromias: a pilot study to assess patient satisfaction, safety, and willingness to pay. Ann Plast Surg. 2015;74(supp 4):S204–8.

    Article  CAS  PubMed  Google Scholar 

  38. Kontoes PP, Marayiannis KV, Vlachos SP. The use of intense pulsed light in treatment of scars. Eur J Plast Surg. 2003;25:374–7.

    Google Scholar 

  39. Ha JM, Kim HS, Cho EB, et al. Comparison of the effectiveness of nonablative fractional laser versus pulsed-dye laser in thyroidectomy scar prevention. Ann Dermaoloty. 2014;26(5):615–20. This article compared the use of nonablative fractional lasers versus pulsed dye laser for the treatment of post surgical scars and showed no difference in improvement between the tow modlaities. Both types of lasers improved the scar appearance without significant difference between the two.

    Article  Google Scholar 

  40. Shin JU, Gantsetseg D, Jung JY, et al. Comparison of non-ablative and ablative fractional laser treatments in a postoperative scar study. Lasers Surg Med. 2014;46:741–9.

    Article  PubMed  Google Scholar 

  41. Chadwick S, Heath R, Shah M. Abnormal pigmentation within cutaneous scars: a complication of wound healing. Indian J Plas Surg. 2012;45(2):403–11.

    Article  Google Scholar 

  42. Velangi SS, Rees JL. Why are scars pale? An immunohistochemical study indicating preservation of melanocyte number and function in surgical scars. Acta Derm Venereol. 2001;81:326–8.

    Article  CAS  PubMed  Google Scholar 

  43. Alexiades-Armenakas MR, Bernstein LJ, Friedman PM, et al. The safety and efficacy of the 308 nm excimer laser for pigment correction of hypopigmented scars and striae. Arch Dermatol. 2004;140:955–60.

    Article  PubMed  Google Scholar 

  44. Glaich AS, Rahman Z, Goldberg LH, et al. Fractional resurfacing for the treatment of hypopigmented scars: a pilot study. Dermatol Surg. 2007;33(3):289–94.

    CAS  PubMed  Google Scholar 

  45. Anbar TS, El-Ammawi TS, Abdel-Rahman AT, et al. The effect of latanoprost on vitiligo: a preliminary comparative study. Int J Dermatol. 2015;54:587–93.

    Article  CAS  PubMed  Google Scholar 

  46. Siadat AH, Rezaei R, Asilian A, et al. Repigmentation of hypopigmented scars using combination of fractionated carbon dioxide laser with topical latanoprost vs fractionated carbon dioxide laser alone. Indian J Dermatol. 2015;60(4):364–8. This article showed that the use of a fractionated carbon dioxide laser and topical lantaoprost can help to improve hypopigmented scars which can be quite difficult to treat.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Massaki AB, Fabi SG, Fitzpatrick R. Repigmentation of hypopigmented scars using an erbium-doped 1550 nm fractionated laser and topical bimatoprost. Dermatol Surg. 2012;38:995–1001.

    Article  CAS  PubMed  Google Scholar 

  48. van Drooge AM, Vrijman C, van der Veen W, et al. A randomized controlled pilot study on ablative fractional CO2 laser for consecutive patients presenting wth various scar types. Dermatol Surg. 2015;41:371–7.

    Article  PubMed  Google Scholar 

  49. Midwood KS, Williams LV, Schqarzbauer JE. Tissue repair and the dynamics of the extracellular matrix. Int J Biochem Cell Biol. 2004;36(6):1031–7.

    Article  CAS  PubMed  Google Scholar 

  50. Lee SH, Zheng Z, Roh MR. Early postoperative treatment of surgical scars using a fractional carbon dioxide laser: a split-scar, evaluator blinded study. Dermatol Surg. 2013;39:1190–6.

    Article  CAS  PubMed  Google Scholar 

  51. Sobanko JF, Vachiramon V, Rattanaumpawan P, et al. Early postoperative single treatment lasing of Mohs micrographic surgery facial scars: a split-scar, evaluator-blinded study. Lasers Surg Med. 2015;47:1–5.

    Article  PubMed  Google Scholar 

  52. Stephan FE, Habre MB, Helou JF. Fractional CO2 laser treatment for a skin graft. J Cosmet Laser Ther. 2016;20:1–2.

    Article  Google Scholar 

  53. Finney R, Torbeck R, Saedi N. Non-ablative fractional resurfacing in the treatment of scar contracture. Lasers Surg Med. 2015. Doi: 10.1002/lsm.22400.

  54. Schulz KK, Walling HW. Fractional photothermolysis improves a depressed alar scar following Mohs micrographic surgery. J Drugs Dermatol. 2010;9(1):66–7.

    PubMed  Google Scholar 

  55. Alster TS, West TB. Treatment of scars: a review. Ann Plast Surg. 1997;39(4):418–32.

    Article  CAS  PubMed  Google Scholar 

  56. English RS, Shenefelt PD. Keloids and hypertrophic scars. Dermatol Surg. 1999;25(8):631–8.

    Article  CAS  PubMed  Google Scholar 

  57. Leventhal D, Furr M, Reiter D. Treatment of keloids and hypertrophic scars: a meta-analysis and review of the literature. Arch Facial Plast Surg. 2006;8(6):362–8.

    Article  PubMed  Google Scholar 

  58. Alster TS, Tanzi EL. Hypertrophic scars and keloids: etiology and management. Am J Clin Dermatol. 2003;4(4):235–43.

    Article  PubMed  Google Scholar 

  59. Jin R, Huang X, Li H, et al. Laser therapy for prevention and treatment of pathologic excessive scars. Plast Reconstr Surg. 2013;132(6):1747–58.

    Article  CAS  PubMed  Google Scholar 

  60. Rossi A, Lu R, Frey MK, Kubota T, Smith LA, Perez M. The use of the 300 microsecond 1064 nm Nd:YAG laser in the treatment of keloids. J Drugs Dermatol. 2013;12(11):1256–62.

    PubMed  Google Scholar 

  61. Cavalie M, Sillard L, Montaudie H, Bahadoran P, Lacour JP, Passeron T. Treatment of keloids with laser-assisted topical steroid delivery: a retrospective study of 23 cases. Dermatol Ther. 2015;28(2):74–8.

    Article  PubMed  Google Scholar 

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Correspondence to Anthony M. Rossi.

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Dr. Michael C. Cameron, Dr. Reyna Swift, Dr. Ashley Wysong, and Dr. Anthony M. Rossi declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Cameron, M.C., Swift, R., Wysong, A. et al. Laser Revision and Rehabilitation of Mohs Micrographic Surgical Scars. Curr Derm Rep 5, 200–207 (2016). https://doi.org/10.1007/s13671-016-0144-7

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  • DOI: https://doi.org/10.1007/s13671-016-0144-7

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