Carbon dioxide laser surgery for skin lesions

Lasers are used in various ways at Great Ormond Street Hospital (GOSH) including the treatment of birthmarks and other skin lesions. Carbon dioxide (CO2) lasers work by sending out a concentrated beam of light that can remove raised or scaly areas of skin. 

Why does my child need laser surgery?

When a birthmark or skin lesion is causing problems, either physical or psychological, it may be best to remove it depending on the type of birthmark. CO2 laser surgery is sometimes suggested as an alternative to traditional surgery as it can remove the top layers of the lesion, often with less scarring.

Depending on your child’s age and the type and location of the lesion, he or she may have treatment under local anaesthetic where just the area treated is made numb) or general anaesthetic. The surgeon will discuss this with you before the procedure is scheduled. 

What are the alternatives to laser surgery?

Traditional surgery is usually the most suitable treatment where the birthmark is excised. 

Pre-admission clinic

This is an outpatient appointment where you will be able to discuss your child’s planned operation, test or procedure with the team before coming in to hospital for your admission. Your child will also have various tests and investigations carried out during this appointment. This avoids any delays on the day of the operation, test or procedure. We may also ask for photographs to be taken of your child’s skin lesion to record it before treatment, so that the improvement afterwards can be measured. 

What happens before laser surgery?

You will receive information on how to prepare your child for the operation in his or her admission letter. The surgeon will need to see you to explain the laser surgery in more detail, discuss any worries you may have and ask you to give permission for the surgery by signing a consent form. If your child has any medical problems, such as allergies, please tell the surgeon. 

What does laser surgery involve?

Once your child is under anaesthetic (either local or general), the area being treated is removed in layers using the laser. At the end of treatment, the area will look like a graze, which will heal and hopefully leave few scars. 

Are there any risks involved?

The risks of laser surgery are the same as with traditional surgery. The area of skin treated will feel sore afterwards and will need careful looking after for the first few weeks. A regular dose of paracetamol according to the instructions on the bottle is usually enough to take away the pain. Putting an ice pack wrapped in a clean tea towel over the treated area can also help to ease the pain. As with any wound, there is a small chance that it could get infected, in which case antibiotics will be needed. The treatment can change the colour of the skin making it darker or lighter. Sometimes, pre-treatment creams are used to reduce this risk. 

What happens afterwards?

Once your child has recovered from the general anaesthetic and is comfortable, you will be able to go home. Depending on how the lesion has been treated, the area may be covered with a dressing to protect it for the first few days. The ward nurses will advise you about the care needed. Sometimes we ask for help from your GP or district nurse. An appointment in our dressing clinic may be arranged for after treatment. We will give you details before you go home. 

When you get home

  • You should give your child regular pain relief such as paracetamol according to the instructions on the bottle for the first two or three days at home.
  • Your child may be given a course of medicines, usually flucoxacillin and acyclovir, to take for five days. The entire course should be finished.
  • Laser treatment removes the top layer of skin leaving a wound similar to a graze or burn. The treated area will be pink and the new skin is very fragile. It will remain like this for several months. The area may weep yellow fluid for the first few days. This is normal.
  • The treated area must be kept moist with liquid paraffin to prevent it becoming crusty. It is difficult to keep a liquid paraffin dressing on the face or neck, so we suggest applying liquid paraffin emollient cream regularly. If a dressing is in place, it is usually a ‘sandwich’ of paraffin gauze dressing, plain gauze dressing secured with a bandage. We will advise when your child can have a shower or bath but the water temperature should not be too hot. Wash the skin including the treated area with a mild soap or aqueous cream and gently pat the area dry with a towel. Do not rub the skin as this will make it sore.
  • When the treated area has stopped crusting, usually in a week or two, you can smooth on some bland moisturising cream such as E45® or Nivea®. You should apply the cream three to four times a day.
  • Avoid exposure to the sun as sun can darken the treated area. Always use a total sunblock of SPF 30 or higher whenever your child goes outside and avoid excess sun exposure.
  • Make up should be avoided on the treated area for one to two weeks.
  • Your child should not go swimming for two to four weeks and avoid PE or games for one to two weeks.

You should call us if:

  • Your child is in a lot of pain and pain relief does not seem to help.
  • Your child has a temperature of 38°C and paracetamol does not bring it down.
  • The treated area of skin oozes a great deal or starts to smell.
Compiled by: 
Plastic Surgery in collaboration with the Child and Family Information Group This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals.
Last review date: 
August 2014
Ref: 
2014F0689

Disclaimer

Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.