​​​​​​​​​​​​​鍾經略醫生【皮膚科碩士 x 美容醫學碩士】課程研究​

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Clinical Case Report: Aesthetic Removal of a Facial Pigmented Nevus via Carbon Dioxide Laser Ablation

Patient Presentation and Lesion Description

The patient presented with a solitary, well-circumscribed, elevated pigmented lesion located on the central forehead, approximately 1.5 cm in diameter. Clinically, the lesion exhibited a dome-shaped morphology with a homogenous brown to dark-brown pigmentation and a smooth, slightly verrucous surface texture. The borders were sharply demarcated from the surrounding skin, with no evidence of asymmetry, ulceration, or irregular pigment network on dermoscopic assessment. Based on clinical morphology and location, the lesion was diagnosed as a benign compound or intradermal melanocytic nevus.

Given its prominent facial location and the patient’s aesthetic concerns, surgical excision with primary closure was considered but declined in favor of a minimally invasive approach to minimize scarring and downtime.

Intervention: CO₂ Laser Ablation

The lesion was treated using a high-precision, pulsed carbon dioxide (CO₂) laser system under local anesthesia. This ablative technique selectively vaporizes tissue layers with micron-level control, allowing for precise depth modulation without significant bleeding or requirement for sutures. The procedure was performed in a single session with sequential passes, titrating energy fluence and pulse duration to achieve complete ablation of the nevus while preserving the underlying dermis.

Intraoperatively, hemostasis was maintained through controlled thermal coagulation inherent to the CO₂ laser mechanism. Post-procedure, the wound bed was covered with a non-adherent dressing and topical antibiotic ointment to promote epithelialization and prevent infection.

Postoperative Outcome (4-Month Follow-Up)

At four months post-ablation, the treated site demonstrates excellent cosmetic outcome with near-complete resolution of the nevus. Minimal residual erythema is present, consistent with normal healing, and there is no clinically apparent hypertrophic scarring, atrophy, or textural distortion. The epidermis has fully re-epithelialized, with uniform pigmentation matching adjacent skin. No recurrence of the lesion is observed, indicating complete eradication of melanocytic nests.

Technical Considerations and Clinical Expertise

Successful CO₂ laser ablation of pigmented nevi demands exceptional technical proficiency and nuanced understanding of tissue optics and histological layering. The operator must precisely calibrate the depth of ablation to ensure complete destruction of the nevus cells residing within the epidermis and papillary dermis, while avoiding excessive penetration into the reticular dermis — which risks collagen disruption and subsequent scar formation.

Under-treatment may leave residual melanocytes, predisposing to recurrence; over-treatment can lead to permanent textural defects or hypopigmentation. Therefore, this modality is highly operator-dependent and should be reserved for experienced practitioners who are adept at real-time intraoperative assessment of tissue response and endpoint determination.

Conclusion

This case illustrates the efficacy and aesthetic superiority of CO₂ laser ablation for the removal of benign facial nevi when performed by an experienced clinician. With meticulous depth control and appropriate postoperative care, this minimally invasive technique offers an excellent alternative to surgical excision, particularly in cosmetically sensitive areas. Patient satisfaction is high, and long-term follow-up will continue to monitor for any late recurrence or delayed scarring.

Prepared by Dr. Chung King-Lueh (Dermatologic Surgery & Laser Therapy case study)

Disclaimer: All procedures performed in accordance with ethical guidelines and informed consent. Histopathological confirmation was not pursued given the classic benign clinical presentation and patient preference.

臨床病例報告：運用二氧化碳雷射進行面部色素痣的美觀性移除

患者臨床表現與病灶描述

患者前額正中部位出現一顆孤立性、邊界清晰、隆起的色素性病灶，直徑約1.5公分。臨床上，該病灶呈圓頂狀，顏色均勻，呈棕色至深棕色，表面質地光滑略帶疣狀。病灶邊緣與周圍皮膚界線分明，無不對稱、潰瘍或皮膚鏡下色素網絡不規則等惡性特徵。根據其臨床形態及位置，診斷為良性混合痣或皮內痣。

考量其位於面部顯眼位置及患者對美觀的重視，雖曾考慮手術切除並一併縫合，但患者傾向選擇微創治療方式以減少疤痕形成及恢復期。

治療方式：二氧化碳雷射汽化

於局部麻醉下，使用高精準度脈衝式二氧化碳（CO₂）雷射系統進行治療。此汽化技術可逐層精準蒸發組織，深度控制精確至微米等級，在不需縫合且幾乎無出血的情況下完成治療。手術分次進行，逐步調整能量密度與脈衝時間，以徹底汽化痣組織，同時保護下方真皮結構。

術中，因CO₂雷射本身具有熱凝固效應，故能維持良好止血效果。術後傷口以非黏性敷料覆蓋，並塗抹抗生素藥膏，以促進上皮再生並預防感染。

術後追蹤（術後四個月）

術後四個月回診評估，治療區域呈現極佳的美觀效果，痣體幾乎完全消失。僅見輕微殘留紅斑，屬正常癒合過程，無明顯肥厚性疤痕、萎縮或質地不平。表皮已完全再生，膚色均勻，與周圍皮膚融合良好，未見病灶復發，顯示痣細胞已徹底清除。

技術要點與臨床經驗的重要性

成功運用CO₂雷射移除色素痣，高度依賴操作醫師的技術熟練度與對皮膚組織光學特性及組織學層次的深入理解。操作者必須精確控制汽化深度，確保徹底清除位於表皮及乳頭層真皮內的痣細胞，同時避免過度深入網狀真皮層，以免破壞膠原結構，造成永久性疤痕。

治療不足可能殘留痣細胞，導致復發；治療過深則易引起組織缺損或色素脫失。因此，此治療方式對操作者要求極高，須由經驗豐富、能於術中即時判斷組織反應並掌握治療終點的專科醫生執行。

結論

本病例充分展現，在經驗豐富的臨床醫生操作下，CO₂雷射汽化為面部良性色素痣提供了一種高效且美觀的治療選擇。透過精準的深度控制與適當的術後照護，此微創技術特別適合用於面部等對美觀要求極高的區域，可作為傳統手術切除的優良替代方案。患者滿意度高，後續將持續追蹤以監測是否有遲發性復發或疤痕形成。

撰文：鍾經略醫生（皮膚外科與雷射治療案例）

免責聲明：所有治療均依循醫學倫理與患者知情同意進行。鑒於病灶具典型良性臨床特徵且患者不願接受組織病理檢查，本次治療未進行病理確診。