AccessDermatologyDxRx Channel

Dermatology Question of the Week: Surgical Skills

This week's question will focus on surgical dermatology.
Go to the profile of Mikael Horissian
Mikael Horissian
Dermatologist, Geisinger Medical Center
Dermatology Question of the Week: Surgical Skills
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A patient presents to you for a laser consultation for spots on face. You discuss the risk of ocular damage with the use of lasers and the importance of proper eye protection. Which of the following  lasers is most associated with corneal/scleral damage?

A. KTP (532nm)

B. PDL (595nm)

C. Alexandrite (755nm)

D. Nd:YAG (1064nm)

E. CO2 (10,600nm)

Rationale: LASER stands for light implication by stimulated emission of radiation. Lasers are monochromatic, coherent, and collimated and the various media can determine the wavelength of light produced. The choice of which type of laser to use depends on the target chromophore. 

Correct answer: E. CO2 (10,600nm)

Lasers that target water such as Nd:YAG (1320nm), Erbium:glass (1500nm), Erbium:YAG (2940nm), and CO2 (10,600nm) can cause corneal or scleral damage due to water content. 

Incorrect answers: A-D

Lasers that target melanin or hemoglobin such as the KTP (532nm), PDL (585-600nm), Ruby (694nm), intense pulsed light, Alexandrite (755nm), Diode (800nm), and Nd:YAG (532 and 1064nm) can cause retinal damage, due to the heavily pigmented retina, as well as damage the uvea and iris. 

Additional reading at Fitzpatrick's Dermatology Chapter 208: Fundamentals of Laser and Light-Based Treatments

Go to the profile of Mikael Horissian
Mikael Horissian
Dermatologist, Geisinger Medical Center

I am a general dermatologist practicing at an academic medical center in Danville, PA. I see both adult and pediatric patients and also perform various surgical procedures. I have a special interest in Hidradenitis Suppurativa (HS) and am the founder of our HS specialty clinic where we treat patients medically and surgically (deroofing, excision, staged CO2 excision with marsupialization, Nd:YAG). I am actively involved in resident education and am passionate about medical education. Additional interests include autoimmune bullous disorders, dermatomyositis, and procedural dermatology. 

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