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Lasers are often used in the treatment of pigmented lesions of the mucosa and skin. Their minimally invasive nature, combined with their efficacy, has placed them at the forefront of therapeutic options for patients with these lesions. This article describes laser basics, identifies common diseases of the skin and mucosa, which can be treated with medical lasers, and explains which lasers are appropriate for which lesions. Potential complications, as well as important laser safety principles, are also discussed. This activity also highlights the role of the interprofessional team in evaluating and improving care for patients undergoing this procedure. Objectives: Identify the disease processes that most commonly lead to pigmented lesions, and describe structures that are involved. Explain the indications and contraindications of laser treatment of pigmented lesions. Describe the equipment, personnel, preparation, and technique in regards to laser treatment of pigmented lesions. Outline the potential complications during laser treatment of pigmented lesions, and how to best avoid them. Discuss interprofessional team strategies for improving care coordination and communication to advance patient safety and improve outcomes. Access free multiple choice questions on this topic.

The acronym LASER stands for Light Amplification by Stimulated Emission of Radiation. At their core, lasers use electromagnetic radiation to excite electrons, causing the electrons to emit photons during the return from their excited state back to a resting state. The energy produced in the form of light travels along a wavelength. Wavelengths that fall within the visible spectrum lie between 400 and 700 nanometers, but various lasers exist which travel on wavelengths of the electromagnetic spectrum that exist outside of the visible spectrum. Since debuting in a medical capacity in the 1960s, medical lasers have become increasingly adaptable to various fields of medicine. The ability of lasers to target specific colors through the use of specific laser wavelengths has assisted in placing lasers at the forefront in the treatment of pigmented lesions, such as vascular lesions of the skin and mucosa, unwanted tattoos, and pigmented nevi. It is critical to have a working understanding of laser function, terminology, and safety before treating pigmented lesions. Of equal importance is an understanding of these pigmented lesions, so that the appropriate laser can be selected for use. This article strives to provide a foundation for such recognition.[1]

Ocular - The Nd: YAG laser, with its ability to be absorbed by the melanin-rich pigment of the retina, can cause retinal hemorrhage, vitreous hemorrhage, retinopathy, preretinal membrane formation, and scarring. Other lasers can damage the lens and the cornea, especially if the beam of the laser is invisible or in the near-visible spectrum. Studies that have published untoward outcomes emphasize the importance of eye shields and safety goggles.[21][32] Unwanted Skin Changes – Temporary erythema and purpura are normal after many forms of laser treatment, but blistering, scarring, and pigmentary changes should not be expected. All such complications have been reported after laser therapy, as a result of thermal injury. It is critical to test a small area of skin for responsiveness in any patient receiving laser therapy, regardless of skin color, before treating the entire affected area. Additionally, patients should be advised about what skin changes are normal after surgery. For example, when the QSRL is used, patients should be counseled that several color changes will occur. Initially, the lesion may turn white, but this generally fades within minutes. Erythema and edema should be expected, followed by crusting and flaking of the skin within approximately 7 to 10 days.[17] Darker Complected Patients – Given the wide absorption spectrum of melanin (250 nm to 1,200 nm) patients with darker skin, which at a cellular level contains copious melanin, can experience a nonspecific thermal injury. The competitive absorption that melanin deposits in the basal layer predispose patients with deeper skin tones to not only have a higher incidence of untoward effects but also can decrease the overall efficacy of laser treatments targeted towards pigment. Patients with intensely pigmented skin, including patients with Fitzpatrick phototype VI skin, can still receive laser treatments, but special considerations must be taken into account. First, it is essential to understand that the absorption of laser energy by melanin decreases as wavelength increases. Therefore, longer wavelengths can penetrate more deeply into the skin while being less absorbed by endogenous melanin. In light of this, lasers with longer wavelengths should be used whenever possible on patients with darker complexions.[17]

All staff members who will encounter lasers must be well-versed in laser safety protocol. Clear communication is essential when verifying that the following measures are in place before firing the laser. Laser Safety – As lasers are necessarily heat generators, great care must be taken in their use. Collateral damage to not only laser patients’ eyes and skin have been reported, but also damage to the eyes and skin of personnel who are in the room during laser operation. Besides, lasers can start airway and fabric fires. The American National Standards Institute (ANSI) and the Occupational Safety and Health Administration (OSHA) have come up with accessible guidelines to protect both patients and personnel involved in medical laser use.[24] Fire Safety – Since flammability is a potential laser hazard, safeguards must be in place in case of an open flame. An open basin of water should be available in case of laser fire. A fire extinguisher should be present in the room. Patient skin near the laser treatment area should be washed free of cosmetic products that might contain alcohol.[22] Laser Sign – The ANSI recommends placement of a laser sign on the outside of each door in which a laser is being used, warning those outside that goggles must be worn, and precautions are being taken.[24] Window Covers – These should be implemented to reduce the accidental escape of a laser beam outside of the laser treatment room.[22]