Long- and short-term histological observations of congenital nevi treated with the normal-mode ruby laser

Erbium: YAG laser treatment efficacy and association with histologic features for giant congenital melanocytic nevi management

BACKGROUND

Limited research exists on laser treatment of giant congenital melanocytic nevus (GCMN).

OBJECTIVE

We sought to elucidate the efficacy of the Erbium: YAG laser on GCMN and the histologic factors associated with a positive clinical response.

METHODS AND MATERIALS

Between 2019 and 2022, we enrolled 30 medium-to-giant CMN patients who underwent Er: YAG laser treatment. All patients received biopsies before and after laser treatments. Clinical efficacy outcomes were evaluated by the investigator's global assessment (IGA), 5-point scale of depigmentation, and Vancouver Scar Scale (VSS) scores at least 6 months after treatment.

RESULTS

Of the 30 cases, 18 (60.0%) showed improvement (IGA score ≥3). Eight (26.7%) patients showed repigmentation. Eight (26.7%) patients developed hypertrophic scars. The average IGA, depigmentation, and VSS scores were 2.93, 3.57, and 3.20. The IGA score was higher (3.24 ± 1.18 vs. 2.22 ± 0.97, p = 0.031) and a lower repigmentation rate (14.3% vs. 55.6%, p = 0.032) was observed in the cases with Grenz zone. The IGA score was higher (3.33 ± 1.24 vs. 2.13 ± 0.89, p = 0.023) and the repigmentation rate was lower (11.1% vs. 50.0%, p = 0.034) also in the cases with the melanocytes nests with aggregation of melanin. Lesions with superficial ablation resulted in less hypertrophic scar formation than those with deep ablation (5.9% vs. 53.8%, p < 0.05).

CONCLUSION

The Er: YAG laser demonstrated effective clinical results for GCMNs. The grenz zone and the melanocytes nests with aggregation of melanin are promising predictors of laser efficacy.

Treatments of palpebral congenital melanocytic nevus: a systematic review

PURPOSE

Palpebral congenital melanocytic nevi (PCMN) is a rare congenital skin lesion affecting the eyelids that can lead to cosmetic and psychological concerns and potential health risks such as malignancy. Several authors have analyzed therapeutical strategies to treat PCMN. However, there was no consensus in the literature. This systematic review aimed to evaluate the effectiveness, safety, and success of treatments of PCMN.

METHODS

We conducted a systematic review following PRISMA guidelines from October 2022 to April 2023. We included all types of study designs that described or compared PCMN treatments and interventions, as well as histology, recurrence, adverse events, patient satisfaction, and malignant transformation. The search strategy was based on specific search words through the following databases: PubMed, Embase, Latin American and Caribbean Health Sciences Literature (Lilacs), Web of Science, and Scopus. Ongoing studies and gray literature studies were included.

RESULTS

We analyzed 25 case reports with 148 participants. The effectiveness, success, and satisfaction with various treatments for PCMN depend on the specific treatment method and the individual patient's case.

CONCLUSIONS

Most of the studies showed that surgical procedures (exeresis) are able to treat PCMN in the eyelid. The variability in outcomes emphasizes the importance of further research to better understand the most effective and safe approaches for treating congenital melanocytic nevi.

Carbon dioxide ablative laser treatment of acquired junctional melanocytic nevi

BACKGROUND

Junctional melanocytic nevi are common. Furthermore, surgical treatment of these nevi can be challenging due to scar formation.

AIMS

The study aims to detect the efficacy and safety of the CO₂ fractional laser for treating acquired junctional melanocytic nevi and usefulness of dermatoscopy for the monitoring of the nevus.

METHODS

We conducted a retrospective review of 618 patients with 1545 facial junctional melanocytic nevi. CO₂ fractional laser was applied to 2-month intervals until complete clearance was reached. The effect of the therapy was monitored by clinical and dermatoscopy. The Global Assessment Scale (GAS) scores were used to assess the results.

RESULTS

1320 nevi (85%) were treated in just one session. In addition, 120 (8%) and 75 (5%) required second and third sessions, respectively. Only thirty nevi (2%) need more than three sessions. Consequently, at the end of one-year follow-up, patients' (97%) and physicians' (95%) GAS scores were rated as excellent and good, respectively. Moreover, hyper/hypopigmentation, fibrosis, dimples, erythema, and scars were observed as side effects at the 1-year follow-up.

CONCLUSIONS

CO₂ laser is effective in completely removing small acquired junctional melanocytic nevus. Furthermore, dermatoscopy appears to be helpful for monitorization of the nevi in the follow-up period.

Congenital melanocytic nevi: where are we now? Part II. Treatment options and approach to treatment

Treatment of congenital melanocytic nevi (CMN) is generally undertaken for 2 reasons: (1) to reduce the chances of cutaneous malignant melanoma and (2) for cosmetic reasons. Over the past century, a large number of treatments for CMN have been described in the literature. These include excision, dermabrasion, curettage, chemical peels, radiation therapy, cryotherapy, electrosurgery, and lasers. Only low-level evidence supporting these approaches is available, and large randomized controlled trials have not been published. This article explores therapeutic controversies and makes recommendations based on the best available evidence.

Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies

Congenital melanocytic nevi (CMN) are evident in 1% to 6% of neonates. In some studies, nevi with clinical, dermatoscopic, and histologic features identical to CMN have had a prevalence of more than 15% in older children and adults, possibly reflecting the "tardive" appearance of nevi programmed from birth. There is ongoing debate about the magnitude of the risk of melanoma and other complications associated with CMN of various sizes and the best approach to management of these lesions. We review the natural history of CMN, including proliferative nodules and erosions during infancy, neurotization, and spontaneous regression, and features of variants such as speckled lentiginous and congenital blue nevi. The risk of melanoma arising within small-sized (<1.5 cm) and medium-sized CMN is low (likely <1% over a lifetime) and virtually nonexistent before puberty. Recent data suggest that melanoma (cutaneous or extracutaneous) develops in approximately 5% of patients with a large (>20 cm) CMN, with about half of this risk in the first few years of life. Melanoma and neurocutaneous melanocytosis (NCM) are most likely in patients with CMN that have a final size of >40 cm in diameter, numerous satellite nevi, and a truncal location. One-third of individuals with NCM have multiple medium-sized (but no large) CMN. In patients at risk for NCM, a screening gadolinium-enhanced magnetic resonance imaging, preferably before age 6 months, and longitudinal neurologic assessment are recommended. Management of CMN depends on such factors as the ease of monitoring (more difficult for large, dark, thick nevi) and cosmetic and psychologic benefits of excision or other procedures. CMN require lifelong follow-up. Periodic total body skin examinations are necessary for all patients with large CMN, even when complete resection (often impossible) has been attempted.

Laser Erbium: YAG no tratamento de nevos melanocíticos

FUNDAMENTOS - Os nevos melanocíticos adquiridos são observados em grande parte da população e o resultado da sua excisão, dependendo da localização, extensão e fatores inerentes ao paciente, pode ser insatisfatório. OBJETIVO - Avaliar o uso do laser Erbium: YAG no tratamento de nevos melanocíticos adquiridos MÉTODOS - Foram selecionados nove pacientes, seis homens e três mulheres, brancos, com idade entre 20 e 60 anos e desejo de remover um nevo melanocítico composto no tronco. Metade do nevo foi tratada com laser, e a outra metade foi utilizada como controle. Após um mês da aplicação, foram avaliados a cicatrização, o resultado estético e a persistência de células névicas e melanina. RESULTADOS - Houve rápida cicatrização e ótimo resultado estético, no entanto, o exame histopatológico demonstrou a permanência de células névicas e melanina em sete e em nove das amostras examinadas, respectivamente. CONCLUSÃO - A utilização do laser Erbium:YAG, com os parâmetros utilizados neste estudo, não foi capaz de destruir completamente as células névicas melanocíticas e a melanina, não sendo, portanto, recomendada para o tratamento dessas lesões, dada a possibilidade de transformação maligna futura.

Treatment of Congenital Nevomelanocytic Nevi with the CO2 and Q-Switched Alexandrite Lasers

BACKGROUND

A variety of treatment options exist for the management of congenital nevomelanocytic nevi (CNN). Surgical treatment has been the traditional approach, but scarring and cosmetic problems are common. Recently, lasers have been used to treat CNN because, in some cases, surgical excisions are inadequate owing to their inaccessible location, size, and depth.

OBJECTIVE

The effects of the combined use of CO2 laser and Q-switched Alexandrite laser on CNN were evaluated.

METHODS

Eleven patients with CNN were enrolled in this study. The surface epithelium was abraded by a CO2 laser. Subsequently, the lesion was treated by a Q-switched alexandrite laser. Repeated treatments were done every 6 weeks. The results were evaluated clinically by both physicians and patients at 2 and 6 weeks after each treatment using a 5-point grade scale.

RESULTS

By the end of the treatments, the average improvement scale assessed by the physicians, with a 5-point grade scale, was 3.82 and that of the patients was 3.73. There were no cases of hypertrophic scar or postinflammatory hyperpigmentaton persisting beyond 2 weeks. There were no recurrences during the 2-year follow-up period.

CONCLUSION

The combined laser treatment is an effective method for the treatment of CNN. The clinical outcome was favorable; the treatment was safer, less painful, and relatively nonscarring; and there was a quicker recovery period and less of a burden to repeat treatment when necessary compared with conventional treatments.

Laser Treatment of Congenital Nevi

Congenital nevi are benign proliferations present at birth that consist of cells normally present in the skin. Many of these lesions are disfiguring and a source of psychosocial impairment. Because of location or extent of the lesion, surgical excision of the nevus may leave a defect without favorable reconstructive options. Laser ablation of such lesions has been used by several clinicians. A review of laser terminology is presented along with a review of nevus of Ota, nevus of Ito, café-au-lait macules, lentigines, and congenital melanocytic nevi. Although good results may be achieved with laser ablation of these lesions, laser treatment modalities for congenital melanocytic nevi remain controversial because of the potential for malignancy.

Treatment of melanocytic nevi

Pigmented nevi are a heterogeneous group of lesions that range from uniquely curable with laser treatment, to partially responsive, to unresponsive or dangerous. This article presents laser and IPL treatment strategies from a clinical perspective for nevi organized by their typical responsiveness. A rationale for surgical excision, laser, and/or medical therapy in individual patients is also presented. Despite significant recent progress, it is clear that much understanding are still lacking about optimal laser treatment for pigmented lesions.

Treatment of Congenital Melanocytic Nevi Using the Combined (Normal-Mode Plus Q-Switched) Ruby Laser in Asians

Clinical response of congenital melanocytic nevus (CMN) to the combined normal-mode ruby laser (NMRL) and Q-switched ruby laser (QSRL) treatment method (ie, NM plus QS) was correlated with the histologic depth of nevomelanocytic nests to predict the efficacy rate and therapeutic outcome of the laser treatment. Thirty-four patients with CMN were treated using the combined (NM plus QS) ruby laser method. The clinical results of the laser treatment demonstrated that 20 had excellent response, 11 had good response, 3 had fair response, and there was no poor response. When correlated with the histologic type, the efficacy rate of the combined ruby laser was significantly higher in the superficial intradermal type than in the others. We conclude that combining the NMRL and QSRL with appropriate parameters to target both superficial and deep nevomelanocytic components provides a greater degree of penetration of laser light.

Ruby Laser Treatment of Congenital Melanocytic Nevi: A Review of the Literature and Report of Our Own Experience

The authors describe the possibilities and advantages of ruby laser treatment of large congenital nevi as an alternative to surgical excision. The literature (from 1980 to 2002) is reviewed and a case report is presented. Literature and the authors' experience show good cosmetic results after ruby laser treatment. Skin texture is improved and there is a considerable reduction in pigmentation and unsightly hair growth. Ruby laser treatment does not result in scarring, mutilation, or functional impairments, in contrast to surgical treatment. Only short outpatient sessions are required, recovery periods are extremely short, and no rehabilitation period is needed. No malignant changes have been reported after treatment with the ruby laser, even after 8 years of follow-up. The results imply that ruby laser treatment could be a valuable new treatment modality for large congenital nevi. It should be considered when patients refuse to undergo surgery, or when surgery would cause severe morbidity. More research should be initiated to assess possible risks and long-term results.

A giant melanocytic nevus treated with combined use of normal mode ruby laser and Q-switched alexandrite laser

We report a combination procedure that can improve the effectiveness of laser removal of giant congenital melanocytic nevi (CMN). A 2-year-old girl with a giant CMN was seen in our outpatient clinic. Histological findings showed a compound nevus without any evidence of malignancy or dysplastic changes. The patient was treated with the normal mode ruby laser and Q-switched alexandrite laser. The lesion was significantly improved in color and cosmetic appearance. Partial hypopigmentation and texture changes were observed. Histological findings showed a marked decrease in the number of junctional melanocytes and the nests in the papillary and reticular dermis. The combined laser treatment is an effective method for the treatment of giant CMN, but further study is warranted to follow-up questions of recurrence and malignant change.

Lasers in dermatology: four decades of progress

Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results. In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.

Congenital melanocytic nevi: treatment modalities and management options

Congenital melanocytic nevi can be cosmetically disfiguring, give rise to melanoma, and suggest the presence of neurocutaneous melanocytosis. Management decisions must be tailored for each patient and each nevus, taking into consideration the risk for developing malignancy, risk for developing symptomatic neurocutaneous melanocytosis, cosmetic implications of having the nevus, cosmetic implications of any resultant surgical scars from their removal, adverse effects that the nevus may have on psycho-social development, and the adverse effects and long-term sequelae of any surgical intervention. The advantages and disadvantages of different modalities used in the treatment of congenital melanocytic nevi are discussed. Organizational flow diagrams are presented to help clinicians in managing patients with different sized congenital melanocytic nevi.

Multicentric malignant melanoma in a giant melanocytic congenital nevus 20 years after dermabrasion in adulthood

BACKGROUND

Dermabrasion is one approach to the treatment of treating giant melanocytic congenital nevi. Treatment is recommended to reduce the risk of spontaneous malignant transformation of giant nevi into malignant melanomas that usually occur in childhood.

OBJECTIVE

To describe the development of a multicentric malignant melanoma in a giant melanocytic congenital nevus after dermabrasion.

METHODS

We report about a 46-year-old male patient who developed a multicentric malignant melanoma in a giant melanocytic congenital nevus. The nevus was located on his left shoulder extending to his neck and chest. Previously, dermabrasion of the nevus was performed twice at the ages of 26 and 28.

RESULTS

To our knowledge, this is the first report of malignant transformation of a giant nevus into a multicentric malignant melanoma diagnosed 20 years after the procedure of dermabrasion.

CONCLUSION

We conclude that a close follow-up of such patients is mandatory.

Treatment of acquired junctional melanocytic naevi by Q-switched and normal mode ruby laser

BACKGROUND

Acquired junctional melanocytic naevi are harmless pigmented lesions of the epidermis, which can be of cosmetic concern. Various therapeutic approaches have been used in the treatment, but all these methods produce postoperative scarring or alterations in skin texture. Pigment laser treatment of benign pigmented lesions has shown a low potential for scarring by selectively targeting melanosomes in melanocytes and keratinocytes.

OBJECTIVE

To find a fast, effective and safe treatment for the removal of acquired junctional melanocytic naevi.

PATIENTS/METHODS

We first studied the effect of the Q-switched and normal mode ruby laser on 12 patients (eight women and four men) with acquired melanocytic naevi. The effect was monitored by histology and clinical photography.

RESULTS

If the response to one treatment with the Q-switched laser mode was not completely effective, the lesions were subsequently treated with one or two sessions with the laser in normal mode. All flat lesions responded completely. After a follow-up period of 1 year they had not recurred. Slightly elevated lesions showed only a partial response, e.g. disappearance of the junctional part of the naevus but recurrence of the dermal part of the naevus. Red-brown junctional naevi as seen in skin types I and II did not respond well to ruby laser treatment.

CONCLUSIONS

The Q-switched ruby laser was very successful in completely removing flat (non-palpable) acquired junctional melanocytic naevi, but not compound naevi, with one to three treatment sessions, without any scarring or pigmentary disturbance.

Nevo melanocítico congênito

O nevo melanocitico congênito está presente em aproximadamente 1% dos recém nascidos. As lesões classificadas como pequenas e medias são relativamente comuns, ao passo que o nevo gigante, maior que 20 cm no maior diâmetro, é uma condição mais rara cuja a incidência esta estimada em 1 para cada 20 mil nascimentos. As lesões melanociticas congênitas pequenas e médias têm um risco de degeneração maligna baixo, raramente ocorrendo na infância. Por outro lado, estima-se um risco entre 5 a 12 % de um melanoma se desenvolver a partir ou relacionado com um nevo gigante, e de regra, metade dos casos ocorrem antes dos 3 anos de idade. Alem da possibilidade de degeneração maligna, o acometimento neurológico e as implicações psicológicas devido ao aspecto estético são dois aspectos importantes relacionados com as lesões gigantes, influindo também na decisão e na abordagem terapêutica.

Effectiveness of the normal-mode ruby laser and the combined (normal-mode plus q-switched) ruby laser in the treatment of congenital melanocytic nevi: a comparative study

The effect of the normal-mode ruby laser (NMRL) and the combined (normal mode plus Q-switched) ruby laser on congenital melanocytic nevi (CMN) was evaluated, and the degree to which both laser treatment regimens remove melanocytes was compared in 15 patients. Each nevus was marked to designate half of the lesion for the NMRL treatment and half of the lesion for combined ruby laser treatment. The efficacy of each laser treatment was correlated with the degree of clinical improvement determined by photographic assessment, histological examination, and melanin reflectance spectrometry before and 3 months after laser treatment. A single treatment using the NMRL with energy fluences of both 20 J per square centimeter and 30 J per square centimeter resulted in a slight, but not significant, improvement in lightening of pigmentation (42.61% and 30.38%, respectively). A better clinical response (excellent to good) and higher percentage of lightening (64.45%-72.43%) was noted in the combined ruby laser-treated areas than the NMRL-treated areas. Histological results showed that the combined ruby laser provided a marked decrease in the number of the nevomelanocytic nests in both the junctional area and the papillary and reticular dermis, whereas the NMRL (with energy fluences of either 20 J per square centimeter or 30 J per square centimeter) caused a decrease in the junctional area and the papillary dermis. None of the nevi had complete clearance of the pigmentation after a single treatment. Therefore, multiple (four to five) treatment sessions are needed to cause complete removal of nevomelanocytic nests in CMN. In conclusion, the combined ruby laser is more effective than the NMRL alone in the treatment of CMN without scarring or textural change of the skin.

Clinical application of lasers in Asians

BACKGROUND

Laser surgery for Asians differs from that for Caucasians in several important respects. In Asians, some conditions such as nevus of Ota are frequently seen and certain adverse reactions, especially postinflammatory hyperpigmentation, tend to be more common.

OBJECTIVE

This article reviews the use of different types of lasers and intense pulsed light (IPL) sources for the treatment of Asian patients.

METHODS

Various cutaneous conditions amenable to laser treatment, including lentigines, nevus of Ota, acquired bilateral nevus of Ota-like macules, port-wine stains, and acne scarring, are discussed. Strategies for the management of postinflammatory hyperpigmentation are offered.

RESULTS

Appropriate selection and careful planning of the treatment can lead to excellent clinical outcome.

CONCLUSION

Lasers and intense pulsed light sources are important tools for the treatment of a wide range of cutaneous conditions in Asians.

Combined use of normal mode and Q-switched ruby lasers in the treatment of congenital melanocytic naevi

Melanocytic naevi are common and they are often removed for cosmetic purposes. In recent years, both the normal mode ruby laser and the Q-switched ruby laser have been used, either alone or in combination, for the removal of congenital melanocytic naevi. However, their success was restricted to partial lightening and incomplete histological clearance. We report a new approach, with combined use of normal mode and Q-switched ruby lasers, that improves the effectiveness of the laser removal of pigmentation in congenital melanocytic naevi.

Combined laser therapy for difficult dermal pigmentation: resurfacing and selective photothermolysis

Treating pigmented lesions of the skin, especially deep dermal pigmentations, are difficult to achieve satisfactory results without complications. To treat dermal pigmentations, such as nevus of Ota and congenital nevus, the combined therapy of a resurfacing laser (CO2) and a selective photothermolytic laser (the Q-Switched Ruby Laser [QSRL]) was tried, and the results were compared with those treated with the QSRL alone. Combined laser therapy has been performed in 47 patients with nevus of Ota since 1995. The mean treatment period was 6 months and the mean number of treatment was five. Of 47 patients, 46 (98%) showed excellent results. To treat congenital nevus, combined laser therapy was used in 15 patients, and 12 (80%) showed good to excellent results. By combining resurfacing and selective lasers, the treatment period has been reduced by 2 to 3 months, and the number of treatments has been reduced two- to threefold. Furthermore, treatment of congenital nevus has become possible, which was not the case with the QSRL alone. The Er:YAG laser can be used for resurfacing instead of the CO2 laser because it causes less thermal damage and faster wound healing.

Response of naevus of Ota to Q-switched ruby laser treatment according to lesion colour

Lesions of naevus of Ota range in colour from light brown to blue, and even greenish-black. To develop guidelines for optimal treatment, we evaluated the number of Q-switched ruby laser treatments required to eliminate the pigmentation of such lesions classified by colour. Over a period of 6 years, we evaluated 151 Japanese patients with naevus of Ota who had been treated with the Q-switched ruby laser at a low energy level (wavelength 694.3 nm; pulse duration 28 x 10-9 s; energy fluence 5 J/cm2; spot size 6.5 mm) every 2 months. Each lesion was classified by colour as brown (n = 22), brown-violet (n = 42), violet-blue (n = 81) and blue-green (n = 6). The 22 predominantly brown lesions attained an excellent (100-95%) or good (95-75%) cosmetic result following three laser treatments in all patients who received this number of treatments. In the 42 brown-violet lesions, 25 of the 29 good or excellent results were achieved after four treatments; the 13 less successful results were in patients who had one to three treatments. In the 81 violet-blue lesions, 54 of the 65 good or excellent results were achieved after four treatments and 64 of 65 after five treatments, whereas all 16 less good results were in patients who had only one to three treatments. However, in the six blue-green lesions, six or more treatments were required to achieve a similarly favourable result. At the end of treatment, the area was virtually free of scarring, and its texture resembled that of the surrounding normal skin. We have confirmed that the use of the Q-switched ruby laser at a low energy level can eliminate the pigmentation of naevus of Ota. While the desired improvement can be obtained within 1 year, the number of treatments appears to depend on the predominant colour of the lesion.