Laser surgery in the medically compromised patient

Dermatology has entered a new dimension with the introduction of the laser. There are expanding clinical indications for laser excision. The CO2 laser in the cutting mode can incise tissue as sharply as finely honed steel, yet its photocoagulative properties allow rapid sealing of blood vessels and lymphatics. The physician can thereby perform in a relatively bloodless surgical field. Minimal adjacent normal tissue is injured, there is less local postoperative edema, and fewer postoperative analgesics are required. Since there is no need to use epinephrine as a local vasoconstrictive agent and there is no need to use electrocoagulation for control of hemorrhage, CO2 laser excision presents less risk to the medically compromised patient. The CO2 laser may also diminish the risk of seeding or spreading neoplastic cells in the perioperative field.