ORLANDO Ablation with a CO2 laser caused no side effects, scarring, or recurrence in a small study of patients with actinic cheilitis, according to Dr. Keyvan Nouri.
In the study, 25 patients with this precancerous condition of the lips were treated at the University of Miami with Lumenis Ltd.'s UltraPulse CO2 laser, said Dr. Nouri at the annual meeting of the Florida Society of Dermatologic Surgeons.
Study subjects were initially treated conservatively, at the device's proprietary density setting of 6, but Dr. Nouri now uses a density of 7 because it allows him to achieve better ablation and a similar side effect profile.
After the first pass over the suspicious and surrounding areas, the treated area was wiped. A second pass was then made at 300 mJ over the suspicious area at a density of 5. The area was then allowed to granulate, said Dr. Nouri, who is professor of dermatology at the University of Miami and director of the university's laser center.
A variety of other actinic cheilitis treatments have been used, including surgical and nonsurgical approaches, but the CO2 laser appears to be a good treatment option, said Dr. Nouri, who owns the UltraPulse laser that was used for the treatment but disclosed having no financial interest in the company that makes the device.
This laser is easier to use than many other modalities, and may be safer as well, he said, noting that other treatments include topical agents (such as 5-fluorouracil, which can be very irritating), chemexfoliation, systemic retinoids, interferon-α, curettage and electrodesiccation, and cryosurgery.
Other advantages of the CO2 laser, he noted, are a minimal risk of transferring precancerous cells and a low risk of infection from the procedure itself. (Most patients are premedicated with antivirals and sometimes with antibiotics.)
"I'm not saying this is a panacea, because even with the UltraPulse there can be a high recurrence rate, but it is a pretty good option," he said.
Most cases of actinic cheilitis (about 97%) occur on the lower lip. Exposure to ultraviolet radiation is a risk factor for the condition, and thus it is particularly common in those with outdoor occupations and hobbies, said Dr. Nouri. Tobacco exposure has also been linked with this condition. Men in the fifth and sixth decades of life are most often affected.
Actinic cheilitis presents as whitish or reddish lesions that are ulcerated, erosive unulcerated, or erosive ulcerated. Histologically, they present as mild epithelial dysplasia with thickening of the keratin and spinous layer.
Connective tissue and perivascular inflammation can also be seen, but basophilic changes within the connective tissue are a universal finding.
A patient with actinic cheilitis is shown before the laser ablation was performed.
The same patient is shown 1 month after treatment with the UltraPulse CO2 laser. Photos courtesy Dr. Keyvan Nouri