Does laser tattoo removal cause scarring?

Tattoo removal was one of a handful of procedures that saw a significant increase (+39%) between 2014 and 2015, according to the 2015 annual statistics of the American Society of Aesthetic Plastic surgeons. And so are patient concerns with the possibility of scarring as an unwanted side effect. However, U.S. researchers recently reported a low incidence of hypertrophic scarring and no cases of keloid scarring following tattoo removal with the Q-switched neodymium-doped:yttrium-aluminum-garnet laser.

In a retrospective review of 1,041 charts of patients treated under one study protocol and with more than five treatment sessions, researchers found three of the patients (or 0.28%) treated with the laser had evidence of hypertrophic scarring. 

These three hypertrophic scars, the researchers write, represented early stage scarring and did not denote extensive or disfiguring lesions. None of the patients studied emerged from their laser tattoo removal treatments with keloids, according to the study.

According to researchers, they used the laser at accurate, protocol-based settings. Treatments were performed at four-week intervals to allow for healing.

While there may be a perception among some patients, even physicians, that hypertrophic scars and keloid formation is associated with tattoo removal, it is more likely a reflection of selecting inappropriate treatment devices, performing aggressive protocols, giving poor post-procedure care or patient confusion about tissue texture changes, dyschromia and these scarring types.

The authors write the incidence of scars they found was lower than even they had anticipated. The study should help providers to better educate patients about what to expect, as well as realistic and theoretical adverse outcomes.

Disclosure: The authors indicated they had no conflicts of interest and no outside funding for the study.

Lisette Hilton

cosmeticsurgerytimes

Cancer surgeons advise against removal of healthy breast

Only certain women with cancer in one breast should have their healthy breast removed in an attempt to prevent cancer, a leading group of breast surgeons maintains.

The new position statement from the American Society of Breast Surgeons comes at a time when more breast cancer patients are asking doctors to remove the unaffected breast—a procedure known as contralateral prophylactic mastectomy.

"Contralateral prophylactic mastectomy is a growing trend that has generated significant discussion among physicians, patients, breast cancer advocates and media," said position statement lead author Dr. Judy Boughey. She is professor of surgery at Mayo Clinic in Rochester, Minn.

However, "it is important for patients to understand it does not improve their cancer outcome and for them to understand the pros, cons and alternatives to [contralateral prophylactic mastectomy]," she said in a society news release.

The surgeons' group believes the procedure should generally be discouraged in average-risk women, whose chances of developing breast cancer in the healthy breast are only 0.1 to 0.6 percent a year.

And research shows that most women with cancer in one breast gain no cancer-prevention benefit from removal of the healthy breast, the society said.

One group at high risk, for whom the surgery might be warranted, includes women with BRCA 1 or BRCA 2 gene mutations. This was the type carried by actress Angelina Jolie, who did not have breast cancer but who underwent prophylactic double mastectomy in 2013 to lessen her chances for the disease.

According to the guidelines, other women who may opt for contralateral prophylactic mastectomy are those with a lifetime breast cancer risk greater than 25 percent who have not had genetic testing, or those who received "mantle" radiation before age 30. The mantle field includes the lymph node areas in the neck, chest, and under the arms.

The surgery may also be appropriate for women with other genetic risks; a strong family history of breast cancer; dense breasts; extreme disease-related anxiety; or concerns about breast reconstruction symmetry.

"Typically, the decision to perform a contralateral procedure is based on a combination of the patient's perceived risk and fear of future breast cancer, anxiety about annual screening and possible additional diagnostic procedures, as well as the uncertainty of physical, emotional and cosmetic surgical outcomes," said statement senior author Dr. Julie Margenthaler. She is a professor in the division of general surgery at Washington University School of Medicine in St. Louis.

Surgeons should make a clear recommendation for or against the surgery from a medical standpoint to each patient, the authors said.

However, patients' values and preferences should also be an important part of a shared decision-making process, according to the statement.

"The society believes that a final treatment plan should be based largely on an analysis of the risks and benefits of contralateral mastectomy, and the patient's perspective on surgery," Margenthaler said.

She added: "Patient education on those risks and benefits, all treatment options and recurrence risks are crucial. A well-planned patient-surgeon discussion to facilitate this is extremely important."

Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, reviewed the new guidelines. She agreed with the advisory, but said the ultimate decision must always be in the patient's hands.

"If a woman is properly counseled and concludes that she wants to move forward with the surgery, a bilateral mastectomy is still an option," Bernik said.

Sometimes breast aesthetics are part of the decision process, she noted.

"One of the most common reasons for a bilateral mastectomy is for symmetry, and this is still a legitimate reason to go forward with removal of both breasts," Bernik said.

"A few of the other reasons include strong family history, aversion to ongoing testing, and extreme emotional anxiety due to testing," she said.

The statement was published July 28 in the journal Annals of Surgical Oncology.

medicalxpress

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The Laser Hair Removal Health Risk That Has Nothing To Do With Your Skin

That burning hair smell could be bad for you — and worse for your clinician.

(Reuters Health) - The smelly “burning hair” smoke released during laser hair removal could be a health hazard, especially for people with heavy exposure to it, researchers report.

The smoke contains chemicals that irritate the airways and are known to cause cancer, Dr. Gary Chuang told Reuters Health by email.

He and his colleagues collected hair samples from two volunteers, sealed the samples in glass jars, treated them with a laser, and captured 30 seconds of laser “plume” (a smoky mix of burnt hair and chemicals).

They found 377 chemical compounds in the smoke, including 20 that are known environmental toxins, such as carbon monoxide, and 13 that are known or suspected to cause cancer, like benzene and toluene, according to a report in JAMA Dermatology.

Chuang, of the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues also measured the concentrations of very fine particles in the plume that could be easily inhaled. They found an eight-fold increase in concentrations of the particles compared with room air before the procedure, even when there was a smoke evacuator nearby.

When they turned the smoke evacuator off for just 30 seconds, the particle count increased more than 26-fold.

The researchers conclude that the burning-hair plume released during laser hair treatment should be considered a “biohazard, warranting the use of smoke evacuators, good ventilation, and respiratory protection.”

“Laser hair removal performed by improperly trained personnel or in an inadequately equipped facility will put both the healthcare workers and patients at risk,” Chuang told Reuters Health. The procedures should be done only in spaces with “an adequate air filtration system and a smoke evacuator,” he advises.

Risks are likely greater for practitioners who may work eight hours straight, Chuang observed – but no studies have yet looked at how much exposure to the burning-hair plume is too much.

“It’s similar to estimating the effect of second-hand smoke - very difficult to do,” Chuang acknowledged. Nevertheless, he stressed, “it’s important to minimize the risks.”

Dermatologist Dr. Delphine Lee of the John Wayne Cancer Institute in Santa Monica, California, urges people to “keep these results in perspective.”

Consider, she wrote in an email to Reuters Health, “how these levels compare to everyday exposures to other carcinogen-laden air,” such as an urban environment with lots of car exhaust or a smoky restaurant.

“There has been no reported epidemic of increased lung disease or other cancer in technicians or health professionals who perform procedures with lasers, people who visit dermatology offices that use lasers, or patients who have frequent laser hair removal,” Lee noted.

“However, this landmark study alerts us to consider the consequences and further studies are warranted to investigate the risk of exposure to laser hair removal plume,” Lee said.

Although the actual risks aren’t yet known, Lee advises both practitioners and consumers “to take some moderate precautions, such as wearing respiratory masks,” during the procedure.

SOURCE: bit.ly/29DQ74N JAMA Dermatology, online July 6, 2016.

Marilynn Larkin

huffingtonpost