Concomitant use of a high-energy pulsed CO2 laser and a long-pulsed (810 nm) diode laser for squamous cell carcinoma in situ.

Patient 1 is a 70-year-old woman that presented with a biopsy-proven lesion of Bowen’s disease [squamous cell carcinoma (SCC) in situ] on the left arm. She was 17 years status postrenal transplantation for which she was taking imuran and prednisone. She recently had a lentigo maligna excised from her cheek. Physical examination revealed a 3 cm 3 cm mildly hyperkeratotic pink/red plaque on the left dorsal arm. Multiple fine black hairs were noted on her arm, including those within the lesion. Patient 2 is a 78-year-old man that presented with a biopsy-proven lesion of Bowen’s disease on the left arm. His past medical history was significant for multiple facial basal cell carcinomas (BCCs). Physical examination revealed a 3.5 cm 4 cm red plaque on the volar surface of the left forearm against a background of dark brown hairs. Patient 3 is a 71-year-old man that presented with a biopsy-proven lesion of Bowen’s disease on the midchest. His past medical history was unremarkable. Physical examination revealed a 2.5 cm 2.5 cm inflamed red plaque on the midchest with multiple, predominantly black hairs emanating from it and the surrounding skin (Figure 1). Each patient was considered for Mohs micrographic surgery versus wide local excision of the Bowen’s disease. Due to a lesion size and a lesion location at risk for hosting a hypertrophic scar (patient 3), a less invasive modality—CO 2 laser resurfacing—was discussed. Each lesion occurred in a hair-bearing region, however, which raised concerns regarding treatment efficacy because of the possibility of follicular epithelial extension of Bowen’s disease too deep for the CO 2 laser to destroy. Therapeutic Challenge