第一幅圖（術前）：
病灶描述：於右側上唇皮膚黏膜處可見一約 3-4 mm 的乳白色、略呈半球狀隆起之結節性病灶。其表面光滑，邊界清晰，無潰瘍或出血現象。
臨床推測：此病灶外觀符合常見的良性表皮增生性病變，如皮脂腺增生 (sebaceous hyperplasia) 或小的皮膚纖維瘤 (dermatofibroma)。由於其位於美觀區且可能因摩擦而增大，故決定進行切除。
第二幅圖（術後即時）：
手術過程：採用二氧化碳激光 (CO2 laser) 進行精準切除，並以可吸收縫線 (absorbable suture) 閉合創口。
創口描述：病灶已完整移除，形成一圓形、深達真皮層的創面，底部可見鮮紅色肉芽組織及少量滲出液。周圍組織有輕微水腫及充血，為正常的術後急性炎症反應。創緣對合良好，無明顯張力。
第三幅圖（拆線後）：
傷口癒合狀態：於拆線後拍攝，顯示創口已完全上皮化，形成一條細緻、平坦的線狀疤痕。疤痕顏色與周圍正常皮膚接近，僅可見極輕微的色素沉著，整體美觀度佳。
功能與美觀評估：傷口癒合良好，無感染、裂開或肥厚性疤痕等併發症。上唇活動自如，未影響正常功能。此結果顯示手術切除與縫合技術得當，預期疤痕將隨時間進一步淡化。
Figure 1 (Preoperative):
Lesion Description:
A 3–4 mm, milky-white, slightly hemispherical, nodular lesion is observed at the mucous membrane of the right upper lip. The surface is smooth, with well-demarcated borders, and no ulceration or bleeding is present.
Clinical Impression:
The lesion’s appearance is consistent with common benign epidermal proliferative conditions, such as sebaceous hyperplasia or a small dermatofibroma. Given its location in a cosmetically sensitive area and the potential for enlargement due to mechanical irritation, surgical excision was elected.
Figure 2 (Immediate Postoperative):
Surgical Procedure:
The lesion was precisely excised using a carbon dioxide (CO₂) laser, and the wound was closed with absorbable sutures.
Wound Description:
The lesion has been completely removed, leaving a circular defect extending into the dermis. The wound bed reveals healthy, bright red granulation tissue with minimal serous exudate. Mild edema and erythema are present in the surrounding tissue—typical features of an acute postoperative inflammatory response. The wound edges are well approximated with no significant tension.
Figure 3 (Post-Suture Removal):
Wound Healing Status:
Photographed after suture removal, the wound demonstrates complete re-epithelialization, resulting in a fine, flat, linear scar. The scar color closely matches the adjacent normal skin, with only minimal residual hyperpigmentation. Overall cosmetic outcome is excellent.
Functional and Aesthetic Assessment:
Healing has progressed without complications such as infection, dehiscence, or hypertrophic scarring. Lip mobility remains fully intact, with no impairment of normal function. These findings indicate that both the surgical excision and closure technique were performed appropriately, and the scar is expected to continue fading with time.
臨床病例報告：CO₂ 雷射汽化合併一期縫合治療上唇白色丘疹 —— 美容與功能性結果
患者表現與病灶描述
患者表現為單一、圓頂狀的白色丘疹，位於上唇人中旁的唇紅緣。病灶直徑約 5 mm，表面光滑、略微透明並帶有珍珠樣光澤，臨床考慮為纖維性丘疹、皮脂腺增生或小型良性角化性增生。未見炎症、潰瘍或色素改變。由於病灶位置顯著且可能造成美容缺陷，建議手術切除。
介入治療：CO₂ 雷射汽化合併一期縫合
病灶在局部麻醉下以高精準脈衝 CO₂ 雷射切除。雷射以控制的汽化模式逐層汽化病灶，確保完全去除並保留周圍健康組織。由於病灶深入真皮且鄰近黏膜皮膚交界，汽化後形成全層缺損。
不同於淺表病灶可採自然癒合，本病例需以細緻不可吸收縫線（6-0 Prolene）進行一期縫合，以達最佳傷口邊緣對合並減少高活動區域的疤痕攣縮。值得注意的是，雖然傷口較深，但術中出血極少，歸因於雷射的熱凝固作用對微血管的止血效果。
術後結果（拆線當日）
術後 5–7 日拆線時，傷口床顯示良好的肉芽組織形成，無感染、裂開或過多滲液。上皮化進展良好，切口線平整線性，僅見輕度縫線道紅斑。未見肥厚性疤痕、萎縮或輪廓變形。最終美容效果極佳，疤痕幾乎不可見，與周圍唇部解剖結構自然融合。
此結果強調了在高活動度及美容要求高的區域（如唇部），精準雷射汽化結合細緻外科技術的重要性。
技術考量與臨床專業
CO₂ 雷射在去除良性皮膚病灶方面提供無與倫比的精準度，尤其適用於面部。然而，當病灶深入真皮或位於複雜解剖區域（如唇紅緣）時，若僅依靠二期癒合，可能導致不良疤痕，因此一期縫合至關重要。
術者必須在徹底去除病灶與保護深層結構（如口輪匝肌或感覺神經）之間取得平衡。臨床經驗是判斷何時需由雷射汽化轉換為傳統縫合的關鍵，同時選擇合適的縫線材料與技術，以確保最佳功能與美容結果。
結論
本病例展示了 CO₂ 雷射汽化合併一期縫合在上唇白色丘疹去除中的成功應用。雖然形成深層傷口，但術後疤痕極小、恢復迅速，凸顯了將先進雷射技術與基本外科原則結合的價值。對於位於高活動度、高美容需求的病灶，此混合方法代表了現代皮膚外科的黃金標準。
Clinical Case Report: CO₂ Laser Ablation and Primary Closure of a Whitish Papule on the Upper Lip — Aesthetic and Functional Outcome
Patient Presentation and Lesion Description
The patient presented with a solitary, dome-shaped, whitish papule located on the vermilion border of the upper lip, adjacent to the philtrum. The lesion measured approximately 5 mm in diameter and exhibited a smooth, slightly translucent surface with a pearly hue, suggestive of either a fibrous papule, sebaceous hyperplasia, or a small benign keratotic growth. No signs of inflammation, ulceration, or pigmentary changes were noted. Given its prominent location and potential for cosmetic disfigurement, surgical removal was indicated.
Intervention: CO₂ Laser Ablation with Primary Closure
The lesion was excised using a high-precision pulsed CO₂ laser under local anesthesia. The laser was employed in a controlled ablative mode to vaporize the lesion layer by layer, ensuring complete removal while preserving surrounding healthy tissue. Due to the depth of the lesion extending into the dermis and its proximity to the mucocutaneous junction, a full-thickness defect resulted post-ablation.
In contrast to purely superficial lesions where sutureless healing is often sufficient, this case required primary closure with fine, non-absorbable sutures (6-0 Prolene) to achieve optimal wound edge approximation and minimize scar contracture in this highly mobile and cosmetically sensitive area. Notably, despite the depth of the wound, there was minimal intraoperative bleeding, attributable to the laser’s inherent hemostatic effect through thermal coagulation of microvasculature.
Postoperative Outcome (Suture Removal Day)
At the time of suture removal (typically 5–7 days postoperatively), the wound bed demonstrated robust granulation tissue formation with no signs of infection, dehiscence, or excessive exudate. Epithelialization was well underway, and the incision line was remarkably flat and linear, with only mild erythema along the suture tract. There was no evidence of hypertrophic scarring, atrophy, or contour deformity. The final aesthetic result was deemed excellent, with near-invisible scarring that blends seamlessly with the surrounding lip anatomy.
This outcome underscores the importance of combining precise laser ablation with meticulous surgical technique—particularly in areas of high mobility and aesthetic demand such as the lips.
Technical Considerations and Clinical Expertise
CO₂ laser ablation offers unparalleled precision for removing benign cutaneous lesions, particularly in facial regions. However, when lesions are deep or involve the dermis, especially in anatomically complex zones like the vermilion border, primary closure becomes essential to prevent unfavorable scarring from secondary intention healing.
The operator must balance aggressive ablation for complete lesion removal against conservative depth control to avoid damaging underlying structures such as the orbicularis oris muscle or sensory nerves. Experience is paramount in determining when to transition from laser ablation to traditional surgical closure, and in selecting appropriate suture material and technique for optimal functional and cosmetic outcomes.
Conclusion
This case illustrates the successful application of CO₂ laser ablation combined with primary suture closure for the removal of a whitish papule on the upper lip. Despite creating a deep wound, the procedure resulted in minimal scarring and rapid recovery, highlighting the value of integrating advanced laser technology with fundamental surgical principles. For lesions in high-mobility, high-aesthetic zones, this hybrid approach represents a gold standard in modern dermatologic surgery.