Gregory S. Keller

Treatment of vascular lesions with a CW yellow dye laser--initial trials.

Thirteen patients with vascular lesions were treated with a CW yellow dye laser. Most of these patients were either poor candidates for argon laser treatment (ALT) or had undergone unsuccessful argon laser treatment. Twelve patients responded with a “desirable”1,2 treatment result. One patient did not respond adequately to have his result classified as “desirable,” though all patients experienced fading of their lesions. None of the patients experienced scarring, epidermal thinning, or hypopigmentation. This lack of complications, associated with an incidence of desirable results in twelve of the thirteen patients, is noteworthy because all but one of the patients with port-wine stain had difficult-to-treat lesions whose treatment is not attempted by many ALT centers. We believe that yellow light has certain advantages over blue-green argon laser light for the treatment of vascular lesions and think that further study is warranted.

Fiber Optic Delivery And Detection System For HpD Photodynamic Therapy

Hematoporphyrin derivative (HpD) photodynamic therapy (PDT) is presently being used to diagnose and treat a variety of tumors in various organs. A number of fiber optics systems have been developed to detect HpD fluorescence for diagnosis and to photodynamically activate it for treatment. Use of single multimode optical fibers with various distal tips have allowed HpD-PDT to be done throughout the human body by interstitial and endoscopic techniques.

Quartz contact probe for use with argon and Nd:YAG lasers

Contact fiberoptic surgery has been an important step in the evolution of modern day laser surgical procedures. Synthetic sapphire tips, attached to the end of a surgical fiber, are an accepted modality. Sapphire tips optically mold the distribution of the lasers energy exiting the fiber. New developments in quartz fiberoptic tips have provided surgeons with similar tissue results as sapphire tips, with greater flexibility, decreased size, and reduced cost. A pilot study was conducted at the Western Institute for Laser Treatment utilizing these quartz fibers in research and progressing into clinical procedures. The development was through a laser peripheral company; Laserguide Inc.

Rational anatomical treatment of basal cell carcinoma with photodynamic therapy

Skin cancer is epidemic in the United States. A recent national cancer survey identified over 400,000 new cases of skin cancer in a single year and estimated that 40-50% of people who live to be 65 years of age will develop at least one skin cancer.1 The majority of these tumors are basal cell carcinomas. While current treatment modalities provide satisfactory cure rates for these lesions, the deformities following surgery can be devastating and provide an unsatisfactory quality of life. The author is aware of the anecdotal stories of two patients who have committed suicide following multiple surgical resections and irradiation for multifocal basal cell carcinoma. Photodynamic therapy (PDT) is a relatively new, experimental method of treatment for basal cell carcinomas that has been used by this author since 1 982. Because of its selective treatment nature, PDT has the potential to cause less deformity than surgery in certain patients by treating and preserving normal skin surrounding the areas of tumor that would necessarily be resected in the surgical margins.

Trends in Laser Skin Surgery

The laser has become a useful device in our specialty, facial plastic surgery. Current uses of the laser were reviewed at a recent course conducted by the American Academy of Facial Plastic and Reconstructive Surgery, Denver, at its 1987 spring meeting. Highlights of this course and other trends in laser skin surgery are reviewed in this article. CARBON DIOXIDE LASER Course directors, Arlen Myers, MD, Denver, and Fred Stucker, MD, Shreveport, La, discussed the use of the carbon dioxide laser, which is available at many hospitals, clinics, and offices. This laser has many dermatologic uses that have been time tested and some that are controversial. The carbon dioxide laser is useful as a laser scalpel for microscopically controlled resections of nonmelanoma skin cancer. The lesion can be outlined utilizing a 0.2-mm laser spot size with the laser set to a rapidly pulsed mode. The outlined incision can then be grasped