Can the carbon dioxide laser completely ablate basal cell carcinomas? A histological study

Carbon dioxide laser ablation has been advocated as an alternative therapeu tic modality for basal cell carcinoma. This study examined the limitations of carbon dioxide laser ablation for BCCs by the formal excision and histol ogical examination of the tumour bed, following laser therapy. We evaluated the tumour type and ablation depth required to ablate the tumours complete ly. Fifty-one selected BCCs, ranging from 4 to 35 mm, were ablated with a c arbon dioxide laser combined with a microprocessor controlled optomechanica l flash scanner. Clinically there were 21 superficial, 28 nodular and 2 inf iltrative types. Complete ablation at the deep margin was associated with a blation depth (P = 0.006) and with tumour type (P = 0.01). Overall, all tum ours of superficial subtype (found most commonly on the trunk) could be com pletely ablated reliably provided they were lasered to a depth of the middl e dermis or deeper. In contrast, nodular tumours could not reliably be abla ted by this method. A small subset of nodular tumours less than 10 mm diame ter, however, were all completely ablated provided they were lasered to a d epth of the lower dermis or deeper, however this may result in delayed heal ing and scarring. We conclude that this fast modality is useful for the tre atment of some BCCs provided strict selection criteria are met. Laser ablat ion would be most beneficial for patients with multiple superficial BCCs. ( C) 2000 The British Association of Plastic Surgeons.