My Dilemma

 

A 6-year follow-up of a pigment lesion of the left cheek

I experienced and solved a lot of difficult cases in dermatologic laser field. However, I still occasionally encounter patients who make me feel I have yet to learn more about laser treatment. I may have only included successful cases in my presentations and publications to boast my long experience. This flaw, however, is not unique to me. Many speakers at various conferences also flaunt images of drastic improvement. But in fact, in clinical practice, indeterminate and refractory cases abound. 
In this series, I would like to discuss difficult cases that I have encountered in my practice. I call out to specialists in Korea and around the world to provide their valuable opinions and enquiries on matters that have long puzzled me. I openly invite all feedback.

 

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Clinical case

Below is a pediatric female patient who presented with gradually darkening pigment lesion on the left cheek. She was four years old when she first visited my practice.
I have been treating and observing this patient for 6 years. <Images 1-5> show photographs taken each year.

 

Image 1. Initial visit (2008).
Image 2. 3-5 treatments with Q-switched Nd:YAG laser (2009).
Image 3. Er:YAG, IPL treatment (2010).

Image 4. Hair removal laser, long-pulsed KTP, etc. (2011).
Image 5. Laser toning + whitening agent (2012).
Image 6. Laser toning + whitening agent continued (now).

 

As shown in photos, I have used all treatment modalities available for pigment lesions. To summarize the outcome throughout the 6 years, there were sporadic and short periods of improvement. The overall size of the lesion decreased and parts of it did show improvement. However, the remaining irregular and mottled appearance cannot be evaluated as aesthetic improvement on the first condition that the patient initially presented. 

 

What is your opinion? 

- You can see Dr.kim's opinion tomorrow -