Lasers and devices, Calgary South

CO2 laser lesion removal

A focused ablative laser used to remove small benign growths from the skin surface, one lesion at a time. It is precise, it is done under local anesthetic, and it is only ever used on lesions that have been examined and judged benign. Anything with a question over it is biopsied, not lasered.

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What it is

Targeted ablation, not resurfacing

The carbon dioxide laser emits a wavelength that water absorbs strongly. Because skin is mostly water, the beam vapourises tissue exactly where it is aimed and stops there, which is why it can shave a raised growth off flush with the surrounding skin with very little effect on the tissue underneath.

This page is about that focal use: one lesion, or a handful of lesions, removed individually. It is a different procedure from full field CO2 laser resurfacing, where the same device is passed over an entire area to treat wrinkles, texture and sun damage, with a much longer recovery. Same laser, different intent, different aftermath.

Benign onlyUsed on lesions already assessed as benign, never as a way of dealing with something suspicious

Local anestheticDone in clinic, usually in one visit, with the area frozen first

7 to 10 daysTypical crusting time on the face, longer on the trunk and limbs

The most important limit of this treatment: laser removal destroys the tissue it removes, so there is nothing left to send to a pathologist. If a lesion could be a skin cancer, it is biopsied or excised so it can be examined. Lasering a cancer removes the visible part, leaves the rest, and hides it under skin that appears healed. Dr. Kuzel does not do that, and neither should anyone else.

Who it suits

What it is good at, and what it is wrong for

Focal CO2 laser earns its place on small, raised, benign growths where the alternative would be a scalpel and stitches, particularly where there are several to deal with in one sitting.

Seborrheic keratoses. The waxy, stuck on brown or black growths that accumulate with age. Benign, harmless, and often removed because they catch on clothing or are unwanted on the face.
Skin tags. Soft pedunculated growths on the neck, underarms, eyelids and under the breasts, particularly where they rub or catch.
Syringoma. Small firm bumps from sweat ducts, typically clustered under the eyes, where the laser can flatten many lesions in one session.
Sebaceous hyperplasia. The soft yellow doughnut shaped bumps with a central dimple, usually on the forehead and cheeks.
Dermatosis papulosa nigra. The small dark papules common on the face and neck in richly pigmented skin. Treatable, and treated with lower energy and a frank conversation about pigment risk first.
Benign moles that have been assessed. Only where dermoscopy and clinical judgement place the lesion clearly in the benign category, and only after discussing that a shaved mole can regrow and that no specimen will exist afterwards. Where there is any doubt, it is excised instead.
Milia and other small benign bumps. Often removed at the same visit as something else.

Not appropriate for

Any lesion that could be malignant. A spot that is new, changing, growing, asymmetric, irregularly pigmented, bleeding, or not healing is biopsied. It is not lasered while you wait to see what it does. Start with a skin check.
Any atypical or uncertain pigmented lesion. If a mole has features that need a pathologist's opinion, the answer is excision, because the whole point is to look at it under a microscope.
Diagnosed skin cancers. Basal cell and squamous cell carcinoma are treated surgically or with a treatment matched to the biopsy result. See skin cancer treatments.
Active infection, or a cold sore in the area. Treatment is deferred, and antiviral cover is arranged if lesions are being treated around the mouth.
A history of keloid or hypertrophic scarring. Possible in some cases, but the risk of a raised scar has to be weighed against a growth that may be bothering you very little.
Isotretinoin recently, poorly controlled diabetes, or anything that impairs wound healing. Timing is adjusted.
Anyone unwilling to avoid sun on the treated site. Sun on freshly healed skin is the fastest route to a lasting dark mark, particularly in deeper skin tones.

What happens

Assessment first, then the laser

Examination
Every lesion you want removed is examined, with dermoscopy where it is pigmented. Dr. Kuzel is a dermatologist first, and this step is the reason a laser is safe here. Lesions are sorted into benign, uncertain and suspicious.
The decision
Benign lesions can go to the laser. Uncertain and suspicious lesions go to biopsy or excision instead, and he explains why. If that changes the plan you came in with, it changes the plan.
Preparation
The area is cleaned and numbed, usually with injected local anesthetic, sometimes with topical anesthetic for very small lesions. Eye protection is worn by everyone in the room.
Ablation
The laser removes the lesion in thin passes until it is flush with the surrounding skin, with the residue wiped between passes. Each lesion takes seconds to a couple of minutes. There is a burning smell from the smoke evacuator, which is normal.
Dressing
An ointment and often a small dressing are applied. You leave with written aftercare instructions and a plan for how to keep the site moist while it closes.
Review
The sites are checked at follow up. Some thicker lesions need a second pass, and any lesion that recurs or behaves oddly is reassessed rather than simply lasered again.

Healing and risks

Small wounds, real risks

These are shallow wounds, but they are wounds. Told properly, the recovery is unremarkable. Told badly, people are surprised by four weeks of pink marks on their face.

The normal course

Stinging for an hour or two as the freezing wears off. Most people need nothing stronger than acetaminophen, and many need nothing at all.
Each site oozes slightly, then forms a thin crust. On the face the crusts usually lift at about 7 to 10 days. On the trunk, arms and legs it takes longer, often two to three weeks, and the lower legs are slowest.
Underneath, the new skin is pink. That pink fades over several weeks to a few months. Makeup can go on once the surface is intact.
Keep the sites moist with the ointment you are given, do not pick the crusts, and keep them out of the sun. Sunscreen over healed skin, every day, for as long as the mark is visible.

Risks worth understanding before you agree

Post inflammatory hyperpigmentation. A dark mark where the lesion was, caused by the healing response rather than by the laser leaving pigment behind. It is common in Fitzpatrick skin types four to six, and it can take months to fade. It is the main reason treatment in deeper skin tones uses conservative settings, sometimes a test spot first, and strict sun avoidance afterwards.
Hypopigmentation. A pale mark that can be permanent. It shows up more in darker skin and is the risk that cannot be undone.
Scarring. Usually a flat, slightly pale mark. Sometimes a small depression, and occasionally a raised or thickened scar. Deeper ablation to clear a thicker lesion carries more scar risk, which is the trade off against leaving part of it behind.
Infection. Uncommon, and treatable. Increasing redness, pain, swelling or pus after the first few days means call the clinic.
Cold sore reactivation. If you get cold sores, treatment near the mouth can trigger one, so antiviral medication is prescribed in advance.
Recurrence. Seborrheic keratoses, skin tags, syringoma and sebaceous hyperplasia can all come back, and syringoma in particular is known for it. Removing what is there does not stop new ones forming.
No pathology specimen. Worth repeating. Laser removal leaves nothing to examine, which is exactly why it is confined to lesions that have already been judged benign.

If a treated site does not heal, comes back thicker, bleeds, or looks different from the others, book a review. A benign diagnosis is a clinical judgement, and clinical judgement gets rechecked when the skin does something unexpected.

Questions

What patients actually ask

Which lesions can be removed this way?

Benign surface growths: seborrheic keratoses, skin tags, syringoma, sebaceous hyperplasia, dermatosis papulosa nigra, milia, and moles that have been assessed and judged benign. The common thread is that the diagnosis is already settled before the laser is switched on.

How do you know a lesion is safe to laser?

Dr. Kuzel examines every lesion clinically and with dermoscopy first. Anything new, changing, growing, irregular, bleeding or not healing does not get lasered. It gets biopsied or excised, because laser removal vapourises the tissue and leaves nothing for a pathologist to look at. Treating a skin cancer with a laser removes the visible part and hides the rest, which is worse than not treating it at all.

Does it hurt?

The area is numbed first, so during the procedure you feel pressure and heat rather than pain. The freezing itself stings for a few seconds. Afterwards the sites sting mildly for an hour or two, and most people need nothing more than acetaminophen.

How long does it take to heal?

Each site crusts and then lifts, usually at about 7 to 10 days on the face and two to three weeks on the trunk and limbs. The skin underneath stays pink for several weeks to a few months, and lower legs heal more slowly than anywhere else. Plan around social events accordingly.

Will it leave a mark, especially in darker skin?

Possibly. The most common outcome is a temporary dark mark from the healing response, which is more likely in Fitzpatrick skin types four to six and can take months to settle. A permanently paler mark is less common but cannot be reversed. Raised scars are uncommon. In deeper skin tones treatment is done with conservative settings, sometimes a test spot first, and strict sun avoidance afterwards, and if the risk does not suit you the honest answer is to leave a harmless lesion alone.

Will the lesion come back?

It can. Syringoma is the most likely to recur, and sebaceous hyperplasia, skin tags and seborrheic keratoses can all return or appear in new places, because the tendency that produced them has not changed. A treated mole can also regrow pigment. That is one more reason a mole with any uncertainty about it is excised rather than lasered.

What does it cost?

Removing a benign lesion for appearance is not medically necessary care, so it is generally not covered by the Alberta Health Care Insurance Plan. There is no price on this page because the fee depends on how many lesions are treated and how long the session takes. You are given the figure at the consultation, before anything is booked. Medically necessary biopsies and skin cancer surgery are a separate matter and are generally covered.

How is this different from CO2 laser resurfacing?

It is the same laser used in a different way. Lesion removal treats individual growths and leaves the skin around them untouched, with recovery measured in about a week to two on the face. Resurfacing passes over a whole area to treat texture, lines and sun damage, and involves a considerably longer and more involved recovery. If you want both, they are planned as separate conversations.

Book

Start with an assessment

Bring in the spots that bother you and the ones you are unsure about. They get looked at properly first, and only then does anyone talk about how to remove them. If something needs a biopsy instead, you will be told.

Rejuvenation Dermatology Calgary South 10201 Southport Rd SW #102, Calgary AB T2W 4X9 (403) 286-6888 Consultations in English and Czech

Book a consultation Call (403) 286-6888

Related reading: skin checks, lesion excisions, CO2 laser resurfacing.