Case Report: CO₂ Laser Removal of a Black Mole on the Philtrum
Patient and Lesion Characteristics
A 48‑year‑old man presented with a black mole located at the lower end of the philtrum. The lesion had been present for more than 30 years. Clinically, it was benign. The patient requested removal for cosmetic reasons.
Procedure
CO₂ laser ablation was performed with precise control of depth to minimize scar formation. The entire mole, including its root, was vaporized. Eight months after surgery, the scar was almost invisible, and the cosmetic outcome was excellent.
Challenges in Mole Removal at the Philtrum
- Lesion Size and Depth
- The mole was relatively large and had grown in place for decades, resulting in a wide and deep wound after removal.
- The challenge was to excise the entire root while sparing as much normal tissue as possible.
- Determining whether suturing was necessary required clinical judgment and experience, as textbooks and standard dermatology/plastic surgery training provide limited guidance.
- Patient Education
- Patient education after laser mole removal in the philtrum region is crucial, but it is also one of the most challenging aspects of care. This area is prone to contamination from saliva, food sauces, and perspiration, so patients must be reminded to keep the wound clean. The real difficulty lies in motivating patients to consistently follow medical instructions.
- Doctors must teach patients how to eat carefully to avoid food or sauces coming into contact with the wound. This requires patience and repeated guidance, as changing daily eating habits is not easy. Likewise, patients need to be taught how to sneeze, yawn, or speak loudly without overstretching the wound, which could otherwise lead to bleeding or wound dehiscence. These skills are not intuitive, and patients often struggle to master them, so physicians must spend considerable time explaining and demonstrating.
- It is also essential to help patients understand the unique challenges of this region: it is easily contaminated and subject to significant tension changes. These factors make wound healing more complex. While textbooks emphasize “patient expectation management,” in practice the true challenge is motivating patients to comply with instructions and equipping them with the practical skills needed to manage everyday situations.
- In summary, patient education is not simply about providing information—it is a continuous process of behavior modification. Physicians must combine clinical experience with communication skills to ensure proper wound healing and minimize complications in this high‑risk area.
- Infection Control
- Prompt and appropriate antibiotic therapy is essential to prevent infection in this high‑risk area.
- Special Wound Dressing
- Dressings must be carefully selected to protect the wound in this mobile and exposed region.
- Impact on Daily Life
- Patients should be warned that healing in this area may temporarily affect speech, eating, and social interactions, particularly for individuals whose work involves communication.
- Patient Expectations vs. Surgical Responsibility
- While textbooks emphasize managing patient expectations, in reality, when complications or scarring occur, the responsibility lies with the physician. Patient counseling is important, but surgical skill and judgment ultimately determine the outcome.
Conclusion
CO₂ laser ablation of a long‑standing mole on the philtrum is technically challenging due to lesion depth, wound tension, and risk of contamination. Successful outcomes require precise depth control, careful wound management, and thorough patient education. In this case, the scar was nearly invisible at eight months, demonstrating the effectiveness of CO₂ laser treatment when performed with experience and meticulous technique.
病例報告：CO₂ 雷射去除人中下端黑色痣
患者與病灶特徵
患者為 48 歲男性，人中下端有一顆黑色痣，存在逾 30 年。臨床判斷為良性。患者因美容原因要求去除。
手術過程
採用 CO₂ 雷射汽化切除，並精準控制深度以減少疤痕形成。整顆痣連同根部完全去除。術後八個月，疤痕幾乎不可見，美容效果極佳。
人中區域痣去除的挑戰
- 病灶大小與深度
- 痣體積不小，且長期存在，導致術後傷口範圍較大且較深。
- 挑戰在於徹底去除根部，同時盡量保留正常組織。
- 判斷傷口深度及是否需要縫合以改善疤痕外觀，必須依靠臨床經驗，而非教科書或傳統皮膚科／整形外科訓練。
- 患者教育
- 在人中區域進行痣的雷射去除後，患者教育至關重要，但同時也是最具挑戰性的部分。此區域容易受到唾液、食物醬汁、汗液等污染，因此必須提醒患者保持傷口清潔。然而，真正的困難在於如何讓患者持續遵守醫師的指示。
- 首先，必須教導患者在進食時避免食物殘渣或醬汁接觸傷口，這需要耐心的指導與反覆提醒，因為日常飲食習慣往往難以改變。其次，還需教導患者在打噴嚏、打哈欠或大聲說話時，如何減少口部過度張開，以避免牽拉傷口導致出血或裂開。這些技巧並非直覺，患者往往難以掌握，醫師需要投入大量時間去解釋與示範。
- 此外，必須讓患者理解此區域的特殊性：它既容易受污染，又承受顯著的張力變化。這些因素使得傷口癒合更具挑戰性。即使教科書強調「患者期望管理」，但在臨床實際中，真正的難點是如何有效地激勵患者遵守指示，並讓他們具備必要的技巧去管理日常生活中的細節。
- 總結而言，患者教育不僅是傳遞資訊，更是一種持續的行為改變過程。醫師需要結合臨床經驗與溝通技巧，才能在這樣的高風險區域確保傷口癒合順利並減少併發症。
- 感染控制
- 必須及時使用合適的抗生素，以防感染。
- 特殊傷口敷料
- 需選擇適合此活動度高且暴露區域的敷料，以保護傷口。
- 對日常生活的影響
- 應提醒患者，該區域傷口癒合可能暫時影響說話、進食及社交活動，尤其是需要頻繁溝通的職業如業務人員。
- 患者期望與醫師責任
- 雖然教科書強調患者期望管理，但實際上，一旦出現併發症或疤痕，責任仍由醫師承擔。患者教育固然重要，但最終結果取決於醫師的技術與判斷。
結論
CO₂ 雷射去除人中區域長期存在的黑痣具有技術挑戰，包括病灶深度、傷口張力及污染風險。成功的結果依賴精準的深度控制、妥善的傷口處理及充分的患者教育。本例術後八個月，疤痕幾乎不可見，顯示 CO₂ 雷射在此敏感區域的有效性與優勢。