Treatment of Porokeratosis of Mibelli with CO₂ Laser Vaporization Versus Surgical Excision with Split‐Thickness Skin Graft: A Comparison

BACKGROUND. Porokeratosis of Mibelli has been treated with many topical surgical modalities in the past, including cold steel surgical excision and CO₂ laser excision. We report a patient with an 8 × 10 cm² plaque of porokeratosis on the dorsum of his hand, fingers, and web spaces. OBJECTIVE. To compare the treatment results of CO₂ laser vaporization versus cold steel surgical excision with split‐thickness skin graft placement. METHOD. The portions of the lesion overlying the metacarpophalangeal joints, fingers, and web spaces were treated with CO₂ laser vaporization. The remainder of the lesion covering the dorsum of the hand was excised with cold steel, followed by placement of a split‐thickness skin graft over that area. RESULTS. The portion of the porokeratosis lesion treated with CO₂ vaporization healed with results cosmetically and functionally superior to the grafted area. CONCLUSION. Carbon dioxide laser vaporization, a more superficial treatment modality than CO₂ laser excision, should be the preferred treatment modality for porokeratosis lesions. 1993 American Society for Dermatologic Surgery, Inc.