Essay: Scarless removal of skin mole using CO2 laser – Distinguishing the Root of a Mole from Surrounding Normal Tissue
論文：雷射無疤除痣的關鍵－如何區分痣的根部與周圍正常組織
鼻子上面有２顆淺色的痣。左邊的比較大。右邊的比較小。2 light colour skin moles on the nose. The one on the left is bigger and the one on the right side is smaller.
Appearance of the wounds after laser mole removal
Appearance of the wounds after laser mole removal
Appearance of the wound after laser mole removal depends greatly on depth control. It is of utmost importance to manage the treatment depth carefully. If the wound is too deep, the resulting scar may be unsightly. If it is too shallow and the mole is not fully removed, the procedure may need to be repeated—repeated damage to the skin can also lead to noticeable scarring.
Mastery of laser procedures relies heavily on clinical experience—it’s not something you can gain just by reading medical textbooks or watch youtube videos
激光去除墨痣後的傷口外觀與治療深度控制密切相關。精準掌握治療深度至關重要：若傷口過深，可能導致明顯疤痕；若過淺而墨痣未完全清除，則需重複療程，而反覆損傷皮膚也會造成明顯疤痕。
激光治療講求實戰經驗，這些技巧無法單靠閱讀醫學教科書或觀看 YouTube 影片就能掌握的。
右邊的較小墨痣已經完全復原癒合. The smaller mole on the right side is 100% healed and leaves no scar
左邊的較大墨痣90%癒合，少少結焦會很快脫落. The bigger mole on the left side heals to 90%. There is still some scab on the wound and will fall out in a weeks’ time.
Essay: Scarless removal of skin mole using CO2 laser – Distinguishing the Root of a Mole from Surrounding Normal Tissue
The successful removal of a mole, particularly by CO₂ laser ablation, depends on accurately identifying the root of the mole and distinguishing it from the surrounding normal tissue. Failure to do so risks incomplete excision, recurrence, or unnecessary damage to healthy skin resulting in unsighty scar.
1. Visual Characteristics (Inspection)
- Color and Pigmentation: Mole tissue often appears darker, denser, or more pigmented than adjacent skin. The root may extend deeper with a uniform or slightly irregular pigmentation compared to the lighter surrounding dermis.
- Texture: Mole tissue is usually thicker or raised, while normal skin is smoother and thinner.
- Margins: The transition zone between mole and normal tissue may show subtle irregularity, requiring magnification or dermatoscopic assessment.
2. Dermatoscopic Analysis
- Pigment Network: Mole roots often display a distinct pigment network or globules under dermatoscopy, absent in normal skin.
- Structural Clues: Features such as radial streaks, dots, or clods can indicate mole tissue extending deeper.
- Vascular Patterns: Normal skin shows fine capillaries, while mole tissue may alter vascular distribution.
3. Histological Understanding
- Melanocyte Clusters: The root of a mole contains nests of melanocytes in the dermis or epidermis, unlike the scattered melanocytes of normal tissue.
- Depth of Involvement: Some moles extend into the dermis or even subcutaneous tissue, whereas normal skin has a uniform epidermal-dermal junction.
4. Intraoperative Clues During Laser Ablation
- Tissue Resistance: Mole tissue often vaporizes differently, with more resistance compared to normal dermis.
- Color Change: As ablation progresses, mole tissue maintains pigmentation until fully removed, while normal tissue appears pale pink.
- Bleeding Pattern: Mole roots may have slightly altered vascularity, producing different bleeding characteristics compared to surrounding skin.
5. Clinical Challenges
- Depth Estimation: Mole roots can extend deeper than expected, risking incomplete removal if only superficial tissue is ablated.
- Cosmetic Considerations: Over‑ablation of normal tissue to “ensure clearance” can cause depressed scars, especially in cosmetically sensitive areas like the nose or periorbital region.
- Recurrence Risk: Leaving residual mole cells at the root increases the chance of regrowth within scar tissue.
Conclusion
Distinguishing the root of a mole from surrounding normal tissue requires a combination of visual inspection, dermatoscopic analysis, histological understanding, and intraoperative observation. Precision is essential: incomplete removal risks recurrence, while excessive ablation damages healthy skin and worsens cosmetic outcomes. Mastery of these distinctions is critical for safe and effective CO₂ laser mole excision.
論文：雷射無疤脫墨的關鍵－如何區分痣的根部與周圍正常組織
成功去除痣，特別是透過 CO₂ 雷射汽化，取決於能否準確辨認痣的根部並將其與周圍正常組織區分開來。若未能正確辨識，可能導致切除不完全、復發，或對健康皮膚造成不必要的損傷，最終留下不美觀的疤痕。
1. 視覺特徵（檢查）
- 顏色與色素沉著：痣組織通常比鄰近皮膚更深、更密或色素更明顯。根部可能延伸更深，呈現均勻或略不規則的色素沉著，而周圍真皮則較淺。
- 質地：痣組織通常較厚或隆起，而正常皮膚則較平滑、薄。
- 邊界：痣與正常組織的過渡區可能顯示細微不規則，需要放大或皮膚鏡檢查。
2. 皮膚鏡分析
- 色素網絡：痣的根部常在皮膚鏡下顯示明顯的色素網絡或色素團塊，而正常皮膚則沒有。
- 結構線索：放射狀條紋、點狀或塊狀結構可提示痣組織延伸更深。
- 血管模式：正常皮膚顯示細微毛細血管，而痣組織可能改變血管分布。
3. 組織學理解
- 黑色素細胞群：痣的根部包含成群的黑色素細胞，位於真皮或表皮，與正常皮膚中分散的黑色素細胞不同。
- 深度影響：部分痣可延伸至真皮甚至皮下組織，而正常皮膚則具有均勻的表皮－真皮交界。
4. 雷射汽化過程中的痣的特徵（術中線索）
- 組織阻力：痣組織的汽化方式不同，通常比正常真皮更具阻力。
- 顏色變化：隨著汽化進行，痣組織保持色素，直到完全去除；正常組織則呈現淡粉紅色。
- 出血模式：痣根部的血管分布可能略有不同，導致與周圍皮膚不同的出血特徵。
5. 臨床挑戰
- 深度估計：痣的根部可能比預期更深，若僅汽化表層組織，可能導致切除不完全。
- 美容考量：為了「確保清除」而過度汽化正常組織，可能造成凹陷性疤痕，尤其是在鼻子或眼眶周圍等美容敏感區域。
- 復發風險：若根部殘留痣細胞，可能在疤痕組織中再次生長。
結論
區分痣的根部與周圍正常組織需要結合視覺檢查、皮膚鏡分析、組織學理解以及術中觀察。精準度至關重要：切除不完全會導致復發，而過度汽化則會損傷健康皮膚並惡化美容效果。掌握這些辨識技巧是安全且有效進行 CO₂ 雷射痣切除的關鍵。