Pigmented lesions

Treatment of normochromic lesions through iatrogenic staining increasing the lesion absorption. (O. Marangoni MD, 1999)

The staining with exogenous chromophores, which modify the tissue thermokinesis, "outwits" the wavelength of different wavelength diode lasers, thus allowing a precise and selective photocoagulation of pigmented and superficial normochromic lesions with significant reduction of the fluencies used.. The mandatory pulsed emission restricts the thermolysis to what had been artificially pigmented.
Any shift from the edges of the beam, due to involuntary movements of the surgeon or unexpected movements of anxious patients or children, does not adversely affect the surrounding healthy tissue, if it is well cooled.
Pale and untanned skin (phototype 1-4) is particularly transparent to I.R. laser radiation.
The advantage is the absence of any form of pain and the localized photothermal destruction of that which has been artificially pigmented.
There are many “exogenous” chromophores that are used as staining agents to vary the tissue thermokinesis, with increased lesion absorption.
Lentigo - Courtesy of L. Scrimali MD
Poikiloderma of civatte - Courtesy of A. Agolzer, MD
Senile keratosis - Courtesy of L. Scrimali, MD
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    Difference between the treatment of pigmented versus vascular lesions It is well known that, in pigmented lesions, melanines are “true targets” for lasers because they absorb laser radiation with mathematical precision such as in the treatment of freckles, milk and coffee spots, ephelides, Papulosis nigra, Civatte’s poikiloderma, hyperkeratotic lesions, age spots, etc. Instead, the haemoglobins from vascular lesions are not true laser targets, but act as “optical bait”, since the true targets are the vessel walls.
    The vaporization-coagulation of erythrocyte hemoglobins produces heat which, by diffusion, causes a thermal endothelitis with:
    • complete destruction of thin-walled ectases and “abundant bait" (angiomas, facial angiectases),
    • incomplete damage and recanalization of thick-walled vascular lesions and "little bait", especially ectases of the lower limbs where the exercise parameters are far greater than those of the face.


    • Warts, condylomas, molluscum contagiosum, papillomas
    • keratoses, leukoplakias, xanthomas, hydroadenomas
    • fibromas and soft fibromas
    • pyogenic and perionychial granulomas
    • benign verrucous nevi
    • epitheliomas
    • polyps
    • cysts
    • general esophytic/benign lesions

    Selective phototermolysis 

    Senile keratosis

    Senile keratosis - Courtesy of L. Scrimali, MD

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