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Great Ormond Street Hospital for Children NHS Foundation Trust: Information for Referrers

Carbon dioxide laser surgery


for skin lesions
This leaflet explains how carbon dioxide (CO2)
lasers can be used to treat skin lesions and what
to expect when your child comes to Great Ormond
Street Hospital for treatment.

What is a carbon dioxide What are the alternatives


(CO2) laser? to laser surgery?
Lasers are used in various ways at Great Traditional surgery is usually the most
Ormond Street Hospital including the suitable treatment where the birthmark
treatment of birthmarks and other skin is excised.
lesions. Carbon dioxide (CO2) lasers work
by sending out a concentrated beam
of light that can remove raised or scaly Pre-admission clinic
areas of skin. This is an outpatient appointment where
you will be able to discuss your childs
planned operation, test or procedure with
Why does my child the team before coming in to hospital for
need laser surgery? your admission. Your child will also have
When a birthmark or skin lesion is various tests and investigations carried
causing problems, either physical or out during this appointment. This avoids
psychological, it may be best to remove it any delays on the day of the operation,
depending on the type of birthmark. CO2 test or procedure. We may also ask for
laser surgery is sometimes suggested as photographs to be taken of your childs
an alternative to traditional surgery as it skin lesion to record it before treatment,
can remove the top layers of the lesion, so that the improvement afterwards can
often with less scarring. be measured.

Depending on your childs age and the


type and location of the lesion, he or
What happens
she may have treatment under local
anaesthetic (where just the area treated is
before laser surgery?
made numb) or general anaesthetic. The You will receive information on how to
surgeon will discuss this with you before prepare your child for the operation in
the procedure is scheduled. his or her admission letter. The surgeon
will need to see you to explain the

Sheet 1 of 3 Ref: 2014F0689 GOSH NHS Foundation Trust August 2014


laser surgery in more detail, discuss any What happens afterwards?
worries you may have and ask you to
Once your child has recovered from the
give permission for the surgery by signing
general anaesthetic and is comfortable,
a consent form. If your child has any
you will be able to go home. Depending
medical problems, such as allergies, please
on how the lesion has been treated, the
tell the surgeon.
area may be covered with a dressing to
protect it for the first few days. The ward
nurses will advise you about the care
What does needed. Sometimes we ask for help from
laser surgery involve? your GP or district nurse. An appointment
Once your child is under anaesthetic in our dressing clinic may be arranged for
(either local or general), the area being after treatment. We will give you details
treated is removed in layers using the before you go home.
laser. At the end of treatment, the area
will look like a graze, which will heal and
hopefully leave few scars. When you get home
You should give your child regular pain
relief such as paracetamol according to
Are there any the instructions on the bottle for the
risks involved? first two or three days at home.
The risks of laser surgery are the same as Your child may be given a course of
with traditional surgery. The area of skin medicines, usually flucoxacillin and
treated will feel sore afterwards and will acyclovir, to take for five days. The
need careful looking after for the first entire course should be finished.
few weeks. A regular dose of paracetamol
Laser treatment removes the top layer
according to the instructions on the bottle
of skin leaving a wound similar to a
is usually enough to take away the pain.
graze or burn. The treated area will be
Putting an ice pack wrapped in a clean
pink and the new skin is very fragile. It
tea towel over the treated area can also
will remain like this for several months.
help to ease the pain. As with any wound,
The area may weep yellow fluid for the
there is a small chance that it could get
first few days. This is normal.
infected, in which case antibiotics will be
needed. The treatment can change the The treated area must be kept moist
colour of the skin making it darker or with liquid paraffin to prevent it
lighter. Sometimes, pre-treatment creams becoming crusty. It is difficult to keep
are used to reduce this risk. 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.

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We will advise when your child can
Notes
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 38C
and paracetamol does not bring it
If you have any questions,
down
please contact the clinical nurse
The treated area of skin oozes a specialists for plastic surgery on
great deal or starts to smell 020 7405 9200 ext 6945

Compiled by Plastic Surgery in collaboration with the Child and Family Information Group

Great Ormond Street Hospital for Children NHS Foundation Trust


Great Ormond Street
London WC1N 3JH

www.gosh.nhs.uk

Sheet 3 of 3 Ref: 2014F0689 GOSH NHS Foundation Trust August 2014