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Some lasers are more equal than others

four treatments. It is of interest to speculate on the mechanism of action of the PDL in these circumstances. The authors stated aim was to utilize a short pulse width, low energy settings and surface cooling in order to deliver a vascular-specific rather than bulk thermal injury. They suggest one possible mechanism to be selective destruction of the supporting vascular network. This is possible, but the PDL at these settings in other circumstances generally does not lead to secondary necrosis of nonvascular structures. It seems probable, as suggested by the authors, that other mechanisms are involved, and stimulation of inflammatory processes secondary to vascular injury may be significant. Little work has been done in this area, but immunological activation has been demonstrated following PDL exposures in other settings. Further studies characterizing the processes taking place in the immediate post-treatment period when treating basal cell carcinoma would be beneficial. As is often the case, this study raises a number of questions. Longer-term follow-up is necessary to establish the true efficacy of this treatment modality. Further investigation should involve double-blind controlled studies incorporating cost– benefit analyses comparing the PDL with other established treatment modalities such as photodynamic therapy and imiquimod. Combining some of these nonsurgical treatments which are likely to be acting by different mechanisms would also be of interest, and may raise the response rates to approach those reported with surgical intervention.