Usually we would recommend that moderate and severe dysplasias are removed, but this decision will need to take in to account many other important factors, including the size and extent of the lesion and the general health of patients. It becomes a balance of the side effects of the treatment (morbidity) with the risk of progression to cancer.

Laser Excision

If the decision has been made to remove an area of dysplasia we would normally recommend excision (removal of the area intact) which has the benefit of giving the opportunity of having the entire lesion assessed by the pathologist.

We know from our data and others that have published that a significant number of dysplasias – around 20% demonstrate areas of early cancer when they are examined by pathologists. We use the laser for this, as it is well tolerated and serves to reduce the side effects for patients, and wounds heal nicely.

Laser Ablation

This is sometimes used as an alternative to ablation and enables removal of a more superficial nature for less concerning areas. Some surgeons advocate the use of this technique around the edges (margins) of the dysplasia.

The concern we have is that the true nature of the lesion can not then be determined or confirmed by pathology.

Monitoring / Close Follow-up

This is certainly a valid option for mild dysplasias in cases where patients are prepared to be seen frequently and take steps to reduce risk factors – namely smoking cessation and alcohol intake.

This is again a decision based on balancing the side effects of having the area removed with risk of progression. For some patients they would prefer to know that it has been removed, others are more comfortable having it monitored.