Dermoscope-guided Laser Excision of a Pilomatricoma – a Novel Surgical Procedure Performed in Primary Care Settings

Hypothesis: Dermoscope-guided laser excision is applicable for some cutaneous lesions seen in primary care, particularly those in body flexures or in regions with high blood perfusion. Summary: A male patient presented with an asymptomatic mass behind his left pinna. Polarised dermoscopy revealed signs compatible with malignancy. Excision was difficult owing to the location being concave and the region being one with hyper-perfusion. Dermoscope-guided laser excision was performed. The edge of the lesion and clear margins were marked via dermoscope-guidance. Laser incisions were made following the margins. Dermoscopy confirmed precision of the incision. Upon three laser-dermoscope cycles, the mass separated itself. Laser in coagulation mode achieved haemostasis. Dermoscope-guided laser excision was performed. The edge of the lesion and clear margins were marked via dermoscope-guidance. Laser incisions were made following such margins. Dermoscopy confirmed precision of the incision. Lesion incisions and dermoscopy were then reapplied. Upon three laser-dermoscope cycles, the mass separated itself. Laser in coagulation mode achieved haemostasis. Outcome: The histopathological diagnosis was a pilomatricoma. Healing was uneventful, with minimal scarring. There was no relapse one year post-operatively. Recommendation: Investigations on dermoscope-guided laser incision and other dermoscope-guided surgical procedures in primary care settings can be conducted to evaluate the outcomes of these procedures.