Clear cell acanthoma successfully treated with a carbon dioxide laser

BACKGROUND. The treatment of choice for clear cell acanthoma (CCA) is excision. Resolution after cryotherapy has also been reported but requires three to four courses of treatment. OBJECTIVE. To demonstrate three CCA lesions in two patients successfully treated with a carbon dioxide (CO₂) laser. METHODS. Under local anesthesia, these lesions were vaporized by using a CO ₂ laser in the Silktouch mode with a spot size of 5 mm and a fluence of 20 J/cm². Two to six passes, as needed, were delivered until the tumor was completely removed. RESULTS. Pain was minimal or nonexistent during and after the operation. No postoperative edema was noted. The wounds healed satisfactorily without scarring. No sign of recurrence was found following operation. CONCLUSION. The CO₂ laser has the advantages of requiring only one course, precise tumor removal, a relatively bloodless surgical field, a short operation time, and less or no postoperative pain and edema. Postoperative wound care is convenient and easy with hydrocolloid and alginate dressings. The patient's quality of life is less adversely affected. The CO ₂ laser may be appropriate for multiple CCAs, giant CCA, CCA overlying or near joints, CCA refractory to cryotherapy, patients on anticoagulants, and those who cannot tolerate pain from cryotherapy, especially children and the elderly.