Treatment of angiofibromas with a scanning carbon dioxide laser: A clinicopathologic study with long-term follow-up

Background: Facial angiofibromas in tuberous sclerosis have been managed wi th various treatment modalities, including carbon dioxide (CO2) laser resur facing. Objective: Our purpose was to perform a long-term clinicopathologic assessm ent of CO2 laser treatment of angiofibromas. Methods: This was a retrospective case review of 10 patients treated with a scanning CO2 laser to flatten lesions. Baseline clinical photographs and t hose taken at 6, 12, and 24 months after the operation were assessed by a b linded observer. Patients also evaluated outcomes. Biopsy specimens taken i mmediately and at 4 months after the operation were reviewed. Results: Three groups of patients were identified: the first comprised 2 pa tients with sustained excellent and good outcomes. A second group (3 patien ts) had excellent outcomes in the early and medium term but then demonstrat ed partial deterioration. The last group (5 patients) had a range of early results with invariably poor outcomes at 24 months. In contrast, patients' self-assessment at 24 months was good or excellent in 8 of 10 cases. All bi opsy specimens taken immediately after the procedure demonstrated ablation extending into the papillary dermis. Residual angiofibromas were present in 6 biopsy specimens. At 4 months, all biopsy specimens showed a band of sup erficial dermal fibrosis, but distinguishing between this and adjacent angi ofibromas was often difficult. Long-term side effects included 2 cases of s ubtle hypopigmentation. Conclusion: The long-term results of CO2 laser treatment of angiofibromas a re unpredictable. The marked improvement obtained at 6 months is sustained in only a minority of cases at 24 months. Despite this, patient satisfactio n appears relatively high. initial clinical improvement may be the result o f a combination of destruction of angiofibromas and their sequestration und er postoperative fibrosis. The benefits of therapy should be weighed agains t both early morbidity and the risks of long-term complications such as sca rring and hypopigmentation.