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Medical Report: CO₂ Laser Vapourisation of Benign Pigmented Nevus – Left Neck Near Hairline

Patient: [Redacted for Privacy]
Date of Procedure:  
Procedure Performed: Ultra-pulse CO₂ Laser Vapourisation of Benign Melanocytic Nevus
Anatomic Site: Left neck, immediately adjacent to posterior hairline
Pre-Procedure Diagnosis: Clinically benign pigmented nevus (junctional/compound)
Post-Procedure Assessment: Complete removal with preservation of dermal architecture and hair follicles; no evidence of scarring or recurrence risk

Clinical Summary

A well-circumscribed, dome-shaped, dark brown melanocytic nevus measuring approximately 8 mm in diameter was identified on the left posterior neck, just anterior to the hairline. The lesion was asymptomatic, non-ulcerated, and exhibited uniform pigmentation without atypical features. Given its location near the hairline and patient’s cosmetic concerns, ultra-pulse CO₂ laser vapourisation was selected as the modality of choice for precise, minimally invasive removal.

Procedure Description: CO₂ Laser Vapourisation Technique

The procedure was performed under strict aseptic technique with local anaesthesia (2% lidocaine with adrenaline). The skin was cleansed with 70% alcohol, and a sterile drape was placed to isolate the operative field.

Using an ultra-pulse CO₂ laser system (wavelength 10,600 nm), the nevus was ablated layer by layer with controlled energy settings. The goal was to achieve complete vaporisation of all melanocytic cells while preserving the underlying dermis and adjacent pilosebaceous units.

Critical Technical Considerations:

Depth Control is Paramount:
The depth of laser penetration was meticulously titrated using real-time visual feedback and tactile sensation. The objective was to remove the entire nevus down to the level of the dermo-epidermal junction — sufficient to eradicate all melanocyte nests and prevent recurrence — while avoiding excessive ablation into the reticular dermis, which risks scar formation.

Preservation of Hair Follicles:
The proximity to the hairline necessitated careful avoidance of deep thermal injury to hair follicle bulbs and bulges. The laser was directed tangentially to avoid vertical penetration into follicular structures. Post-laser inspection confirmed intact hair follicles within the wound bed, visible as small, dark puncta surrounded by healthy pink dermis.

Avoiding Dermal Injury:
The laser was discontinued once the base of the wound appeared uniformly pale pink with no residual pigment or nodularity. Histologically, this correlates with complete removal of epidermal and superficial papillary dermal melanocytes while sparing the deeper dermal collagen framework and appendageal structures.

Post-Procedural Findings (Photo Documentation)

Image 1 (Pre-Procedure):
Shows the pre-treatment nevus: symmetric, darkly pigmented, smooth surface, located just anterior to the posterior hairline. No signs of inflammation, ulceration, or asymmetry.

Image 2 (Immediate Post-Procedure):
Demonstrates the treated site after laser ablation. The wound bed is clean, shallow, and devoid of pigment. Key observations include:

Absence of melanocytes: No residual pigmentation indicates complete eradication of melanocytic elements.
Preserved hair follicles: Multiple hair shafts remain visible within the wound margin, confirming that follicular integrity was maintained.
Intact dermis: The wound base shows healthy, vascularized papillary dermis without evidence of coagulative necrosis or deep thermal damage.
No scarring potential: The depth of ablation is confined to the upper dermis (≤ 0.5 mm), well below the threshold for hypertrophic or atrophic scar formation (typically > 1.0–1.5 mm depth into reticular dermis).

Prognosis and Follow-Up

Given the precision of the laser ablation, the likelihood of recurrence is negligible, as all melanocytes have been removed. The preservation of hair follicles ensures natural regrowth of hair in the area without disruption to the hairline. The minimal dermal injury precludes significant collagen disruption, thereby eliminating the risk of scarring.

Follow-Up Plan:

Wound care: Gentle cleansing with saline and application of antibiotic ointment twice daily for 7 days.
Sun protection: Strict UV avoidance and broad-spectrum SPF 50+ for 6 weeks post-procedure.
Clinical review at 4 weeks to assess re-epithelialisation and confirm absence of recurrence.
Optional dermoscopic follow-up at 3 months for reassurance.

Conclusion

This case exemplifies the efficacy and safety of fractional CO₂ laser vapourisation for benign nevi in cosmetically sensitive areas. Success hinges upon meticulous depth control — sufficient to eliminate melanocytic nests but not so deep as to compromise dermal integrity or follicular structures. The post-procedure image confirms optimal outcomes: complete removal, no scarring, preserved hair growth, and low recurrence risk. This technique represents a gold standard for minimally invasive, scar-free nevus removal when executed with precision and anatomical awareness.

近鏡：激光脫墨前​

激光脫墨前​

醫療報告：左頸髮際線附近良性黑色皮膚痣之二氧化碳雷射氣化術

病人姓名：［為保護隱私已隱去］
**手術日期：**
**手術名稱：**超脈衝二氧化碳雷射氣化術（去除良性黑色素細胞痣）
**治療部位：**左側頸部，緊鄰後髮際線
**術前診斷：**臨床診斷為良性色素性痣（交界性／複合型）
**術後評估：**完全清除病灶，保留真皮結構及毛囊，無疤痕形成，無復發風險

臨床摘要

於左側頸部後方、髮際線前方可見一界限清晰、半球狀、深褐色之黑色素細胞痣，直徑約８毫米。病灶無症狀、無潰瘍，色素均勻，無異常特徵。鑑於其位置鄰近髮際線且患者有美容需求，故選擇超脈衝二氧化碳雷射氣化術以達精準、微創之切除效果。

手術過程說明：二氧化碳雷射氣化技術

手術採嚴格無菌操作，術前局部麻醉針（2% lidocaine with adrenaline）。皮膚以70%醫學酒精消毒清潔，並以無菌洞巾隔離手術區域。

使用超脈衝二氧化碳雷射系統（波長10,600 nm），以控制能量參數逐層氣化痣體。目標為徹底蒸發所有黑色素細胞，同時保留下方真皮層與鄰近毛囊結構。

關鍵技術要點：

深度控制至關重要：
雷射穿透深度須透過即時視覺反饋與觸感經驗精確調控。目的為將痣體氣化至表皮與真皮交界層——足以根除所有黑色素細胞巢穴，防止復發——同時避免過度深入網狀真皮層，以免引致疤痕形成。
保護毛囊結構：
因病灶鄰近髮際線，需特別注意避免熱損傷毛囊球部與隆突部。雷射應以切向角度施打，避免垂直穿透毛囊結構。術後檢視確認傷口床內仍可見完整毛囊，顯示毛囊完整性獲保留。
避免真皮層損傷：
當傷口基底呈現均勻淡粉紅色、無殘留色素或結節時即停止雷射。此視覺表現對應組織學上已完全移除表皮及乳頭層真皮之黑色素細胞，同時保留更深層真皮膠原支架與附屬器官結構。

術後觀察結果（影像記錄）

圖像一（術前）：
顯示術前病灶：對稱、深色色素沉著、表面光滑，位於後髮際線前方。無發炎、潰瘍或不對稱跡象。

圖像二（術後即刻）：
顯示雷射氣化後之傷口。傷口床清潔、淺表、無色素殘留。主要觀察發現包括：

黑色素細胞完全清除： 無殘餘色素，證實黑色素細胞已全數根除。
毛囊結構完整保留： 傷口邊緣可見多處毛幹，證明毛囊未受損。
真皮層完好： 傷口基底呈健康血管化之乳頭層真皮，無凝固性壞死或深層熱損傷。
無疤痕形成風險： 氣化深度限於真皮上層（≤ 0.5 mm），遠低於引致肥厚性或萎縮性疤痕之閾值（通常 > 1.0–1.5 mm 深入網狀真皮層）。

預後與追蹤計畫

由於雷射氣化精準，復發可能性極低，因所有黑色素細胞根部均已清除。毛囊結構之保留確保該區域頭髮自然再生，不影響髮際線外觀。輕微真皮損傷排除了顯著膠原破壞，從而消除疤痕形成風險。

追蹤計畫：

傷口護理：每日以生理食鹽水輕柔清潔，並塗抹抗生素軟膏兩次，持續7日。
防曬措施：術後6週內嚴格避免紫外線曝曬，並使用廣譜防曬係數SPF 50+以上產品。
臨床回診：術後4週評估上皮再生狀況，確認無復發。
可選皮膚鏡追蹤：術後3個月進行皮膚鏡檢查以加強確認。

結論

本案例展現超脈衝二氧化碳雷射氣化術於美容敏感區域去除良性痣之高效性與安全性。成功關鍵在於精確控制氣化深度——足以根除黑色素細胞，卻不致損傷真皮或毛囊結構。術後影像證實理想療效：完全清除、無疤痕、毛髮正常生長、復發風險極低。此技術當由具解剖知識與操作經驗之醫師執行時，乃微創、無疤去除痣之黃金標準。

激光脫墨後（近鏡） – 巨大的墨痣已被完全氣化，但可見毛髮的根部仍然被原好保存，其生長不會受到影響。

激光脫墨後​

主診醫生：鍾經略醫生 - 英國倫敦大學臨床皮膚科碩士

碩士頒發機構：英國倫敦大學英皇學院聖約翰臨床皮膚科研究院

皮膚科醫生常見的皮膚問題 - 激光脫墨

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