My Experience Using Lasers for Skin Lesions

This column first ran in Valerie Monroe’s newsletter, How Not to F*ck Up Your Face, which you can subscribe to on Substack.

When I was a teenager, I presented my face to the sun like a sacrificial lamb, praying to the gods to give my pale complexion some color, a hue compatible with the Beach Boys tunes I loved. What I sacrificed was my skin’s health and beauty, because what I got in return was damage of many kinds: hyperpigmentation (dark spots), laxity, and skin cancer (basal cell, removed by Mohs surgery nine years ago). I recently submitted to a treatment aimed at correcting the terrible choice I made to tan when I didn’t know any better. I am now a 73-year-old with decades of experience in the beauty industry and want to do all I can to ensure the good health of my skin.

I consulted with dermatologist Orit Markowitz, M.D., about how I might head off the likelihood of more skin cancers. She recommended FDA-approved photodynamic therapy, which, according to studies, is highly efficient for treating precancerous skin lesions, certain cancerous lesions (superficial, nonmelanoma skin cancer), and enlarged sebaceous glands and acne. (Some health-insurance plans, including Medicare, also cover it.) A salutary side effect: excellent cosmetic results in the gift of improved skin texture.

I’ve had several photodynamic-therapy treatments, the most recent being two weeks ago. Because immediately after the procedure the skin is much more vulnerable to burning with even minimal sunlight, the treatment is best performed in the winter, when the sun is less strong. Markowitz doesn’t offer the treatment after May.

At my recent appointment, my face was scrubbed with a gauze pad soaked in rubbing alcohol and then painted with aminolevulinic acid (ALA), a photosensitizing compound activated by a specific wavelength of daylight. The acid stung, particularly on my just-scrubbed skin, and it sat on my face for about an hour. I sat in the doctor’s office waiting room, trying to look normal and relaxed so as not to frighten prospective patients with my pulsating complexion.

After an hour of marinating, a physician’s assistant rescued me from the waiting room. Back in the treatment chair, I was handed a pair of tight swim goggles to protect my eyes. Then, a metal box approximately the size of a microwave lined with seven rows of glowing tubes was gently maneuvered over my head. It was a tight fit; if you’re the least bit claustrophobic, you want to be loaded up on benzos or listen to a boring podcast like Game of Drones. I was given a little fan to hold on my lap and aim at my face to add a cool breeze to the broiling experience as the lights were turned on for 16 minutes; my skin burned as the ALA was activated. A liberal coat of moisturizer and sunscreen followed the light treatment; I was warned to stay out of the sun for a few days (one dermatologist told me it wouldn’t be a bad idea to hibernate in a dark closet), and then to keep up with the daily sunscreen without fail.

I had, this time, a very “exuberant” response to the treatment. The more pre-cancers on the skin, apparently, the greater the reaction. For over a week, my face continued to shrivel ’til I resembled one of those dried apple dolls, and then, looking very much like a fine leather accessory, started to peel. As I write this, dainty patches of dead skin are flaking off my cheeks like autumn leaves, while a fresh, pink complexion is just beginning to emerge. After around ten days, the flaking will diminish. After two weeks, my skin will look fresh and clear and the few actinic keratoses (precancerous rough spots) I had will be gone. The doctor advises that the best results may require several treatments; I’ve been doing the treatments around once a year.

If you have sun damage, such as actinic keratoses or nonmelanoma skin cancer (basal cell or squamous), you might ask your dermatologist about photodynamic therapy. The unpleasantness of the treatment now could save you more unpleasantness later.

Valerie Monroe , 2024-02-16 20:33:07

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