Carbon dioxide laser ablation could be an alternative treatment for lentigo maligna (LM) when surgery or radiation therapy is not feasible. Carbon dioxide laser ablation may be the most advantageous treatment because it targets lesions in sensitive regions of the body in a short time with only minimal morbidity, according to researchers at the University of Western Ontario. LM, a common precancerous skin lesion, typically is seen in older people with a history of chronic sun damage, and it is commonly located in the head and neck region. The lesion may progress to LM melanoma (LMM), which has the same prognosis as other forms of melanoma. Dr. Haemi Lee and colleagues conducted a retrospective case series review of all patients with primary LM diagnosed and treated between July 2, 1991, and June 29, 2010. They assessed outcomes in managing primary LM through surgical excision, radiation therapy and carbon dioxide laser ablation, which exerts its effect on tissue by vaporizing water-containing cells. Among 73 patients ages 39 to 93 who chose treatment, 27 were treated with surgical excision, 31 with radiation therapy and 15 with carbon dioxide laser ablation. The patients were followed for an average of 16.6 months for surgical excision, 46.3 months for radiation therapy and 77.8 months for carbon dioxide laser ablation. For surgical excision and carbon dioxide laser ablation, the researchers’ findings trended toward lower recurrence rates, but the results were not statistically significant, they said. For surgical excision, the recurrence rates were 4.2 percent, 29 percent for radiation therapy and 6.7 percent for carbon dioxide laser ablation. The findings appeared in a recent issue of JAMA’s Archives of Facial Plastic Surgery (doi: 10.1001/archfacial.2011.66). “Although surgical excision is established as the gold standard of LM and LMM treatment, complete excision is not always feasible in large lesions of the head and neck,” the authors reported. “The decision to perform complete excision in the setting of LM, a noninvasive disease, must weigh the benefits of excision against the morbidity of the procedure.”