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A new approach for treatment of congenital melanocytic nevi with hypertrichosis: the Depilendolaser technique. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01667-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eggen C, Lommerts J, van Zuuren E, Limpens J, Pasmans S, Wolkerstorfer A. Laser treatment of congenital melanocytic naevi: a systematic review. Br J Dermatol 2018; 178:369-383. [DOI: 10.1111/bjd.16094] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
- C.A.M. Eggen
- Department of Dermatology; Erasmus University Medical Centre Rotterdam; Rotterdam the Netherlands
| | - J.E. Lommerts
- Netherlands Institute for Pigment Disorders; Department of Dermatology; University of Amsterdam; the Netherlands
| | - E.J. van Zuuren
- Department of Dermatology; Leiden University Medical Centre; Leiden the Netherlands
| | - J. Limpens
- Medical Library; Research Support; Academic Medical Centre; University of Amsterdam; The Netherlands
| | - S.G.M.A. Pasmans
- Department of Dermatology; Erasmus University Medical Centre Rotterdam; Rotterdam the Netherlands
| | - A. Wolkerstorfer
- Netherlands Institute for Pigment Disorders; Department of Dermatology; University of Amsterdam; the Netherlands
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Delker S, Livingstone E, Schimming T, Schadendorf D, Griewank KG. Melanoma diagnosed in lesions previously treated by laser therapy. J Dermatol 2016; 44:23-28. [PMID: 27345456 DOI: 10.1111/1346-8138.13484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/13/2016] [Indexed: 11/28/2022]
Abstract
Laser therapy has become a routine procedure in dermatological practice and is frequently also used for pigmented lesions. Few reports exist of melanomas diagnosed in lesions previously treated by laser therapy. Between 2007 and 2014, we identified 11 patients who presented to our department with a melanoma diagnosed in a region previously treated by laser therapy. The course of events until the diagnosis of melanoma was assessed as well as patient outcome including treatment for disease progression. No histological assessment had been performed prior to laser therapy in nine of 11 (82%) cases. Benign melanocytic lesions had been diagnosed by biopsy prior to laser therapy in the other two cases. Time from laser therapy to diagnosis of melanoma ranged from less than 1 to 10 years. Stage of disease at diagnosis varied from stage IA to IIIC. Four patients progressed to stage IV disease, of whom at least one died of melanoma. We conclude that laser treatment of pigmented lesions can complicate the diagnosis of melanoma and lead to diagnosis delay with potentially fatal consequences. Considering this risk, we believe laser therapy for pigmented lesions should either be avoided entirely or at a minimum performed only after prior histological assessment.
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Affiliation(s)
- Sarah Delker
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Tobias Schimming
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Klaus G Griewank
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
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Laser treatment of congenital melanocytic nevi: a review of the literature. Lasers Med Sci 2015; 31:197-204. [DOI: 10.1007/s10103-015-1833-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
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Sardana K, Chakravarty P, Goel K. Optimal management of common acquired melanocytic nevi (moles): current perspectives. Clin Cosmet Investig Dermatol 2014; 7:89-103. [PMID: 24672253 PMCID: PMC3965271 DOI: 10.2147/ccid.s57782] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although common acquired melanocytic nevi are largely benign, they are probably one of the most common indications for cosmetic surgery encountered by dermatologists. With recent advances, noninvasive tools can largely determine the potential for malignancy, although they cannot supplant histology. Although surgical shave excision with its myriad modifications has been in vogue for decades, the lack of an adequate histological sample, the largely blind nature of the procedure, and the possibility of recurrence are persisting issues. Pigment-specific lasers were initially used in the Q-switched mode, which was based on the thermal relaxation time of the melanocyte (size 7 μm; 1 μsec), which is not the primary target in melanocytic nevus. The cluster of nevus cells (100 μm) probably lends itself to treatment with a millisecond laser rather than a nanosecond laser. Thus, normal mode pigment-specific lasers and pulsed ablative lasers (CO2/erbium [Er]:yttrium aluminum garnet [YAG]) are more suited to treat acquired melanocytic nevi. The complexities of treating this disorder can be overcome by following a structured approach by using lasers that achieve the appropriate depth to treat the three subtypes of nevi: junctional, compound, and dermal. Thus, junctional nevi respond to Q-switched/normal mode pigment lasers, where for the compound and dermal nevi, pulsed ablative laser (CO2/Er:YAG) may be needed. If surgical excision is employed, a wide margin and proper depth must be ensured, which is skill dependent. A lifelong follow-up for recurrence and melanoma is warranted in predisposed individuals, although melanoma is decidedly uncommon in most acquired melanocytic nevi, even though histological markers may be seen on evaluation.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology and STD, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Delhi, India
| | - Payal Chakravarty
- Department of Dermatology and STD, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Delhi, India
| | - Khushbu Goel
- Department of Dermatology and STD, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Delhi, India
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Alshami MA. Long-pulsed 532-nm Nd:YAG laser treatment for small acquired melanocytic nevi in a single session: an 8-year study on 350 Yemeni patients. J COSMET LASER THER 2013; 16:14-20. [DOI: 10.3109/14764172.2013.854631] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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8
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Ibrahimi OA, Alikhan A, Eisen DB. Congenital melanocytic nevi: where are we now? Part II. Treatment options and approach to treatment. J Am Acad Dermatol 2012; 67:515.e1-13; quiz 528-30. [PMID: 22980259 DOI: 10.1016/j.jaad.2012.06.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/04/2012] [Accepted: 06/07/2012] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Omar A Ibrahimi
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
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Duffy K, Grossman D. The dysplastic nevus: from historical perspective to management in the modern era: part II. Molecular aspects and clinical management. J Am Acad Dermatol 2012; 67:19.e1-12; quiz 31-2. [PMID: 22703916 DOI: 10.1016/j.jaad.2012.03.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The dysplastic nevus is a discreet histologic entity that exhibits some clinical and histologic features overlapping with common nevi and melanoma. These overlapping features present a therapeutic challenge, and with a lack of accepted guidelines, the management of dysplastic nevi remains a controversial subject. Although some differences between dysplastic and common nevi can be detected at the molecular level, there are currently no established markers to predict biologic behavior. In part II of this continuing medical education article, we will review the molecular aspects of dysplastic nevi and their therapeutic implications. Our goal is to provide the clinician with an up-to-date understanding of this entity to facilitate clinical management of patients with nevi that have histologic dysplasia.
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Affiliation(s)
- Keith Duffy
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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Abstract
Dysplastic nevi have been a subject of much debate since their original description in 1978. Although some question the biological potential of dysplastic nevi themselves, several studies have shown that their presence confers substantial risk for melanoma. In addition to predisposing patients to melanoma, dysplastic nevi have been shown to harbor genetic mutations, indicating their position on a continuum between banal nevi and melanomas. Dysplastic nevi are also clinically relevant as mimickers of melanoma, and can be challenging diagnostically. This article reviews the history, epidemiology, biology and genetics, clinical features, histopathologic features, and management guidelines for patients with these lesions.
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Affiliation(s)
- Michele J Farber
- Jefferson Medical College, Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA 19107, USA
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Paradela S, Fernández-Torres R, Fonseca E. Controversias en el nevus congénito. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)71903-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kishi K, Okabe K, Ninomiya R, Konno E, Hattori N, Katsube K, Imanish N, Nakajima H, Nakajima T. Early serial Q-switched ruby laser therapy for medium-sized to giant congenital melanocytic naevi. Br J Dermatol 2009; 161:345-52. [DOI: 10.1111/j.1365-2133.2009.09153.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Coverage of Large Pediatric Wounds With Cultured Epithelial Autografts in Congenital Nevi and Burns: Results and Technique. J Burn Care Res 2009; 30:576-86. [DOI: 10.1097/bcr.0b013e3181ac02de] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Paradela S, Fernández-Torres R, Fonseca E. Controversial Issues in Congenital Nevi. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70123-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
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.
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Surgical Management of Large and Giant Congenital Pigmented Nevi of the Lower Extremity. Plast Reconstr Surg 2008; 121:1674-1684. [DOI: 10.1097/prs.0b013e31816aa08f] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marghoob AA, Borrego JP, Halpern AC. Congenital Melanocytic Nevi: Treatment Modalities and Management Options. ACTA ACUST UNITED AC 2007; 26:231-40. [DOI: 10.1016/j.sder.2008.03.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hafner C, Stempfl T, Bäumler W, Hohenleutner U, Landthaler M, Vogt T. Gene Expression Profiling of Melanocytes following Q-Switched Ruby Laser Irradiation. Dermatology 2007; 216:6-13. [DOI: 10.1159/000109352] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 04/17/2007] [Indexed: 11/19/2022] Open
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Chong SJ, Jeong E, Park HJ, Lee JY, Cho BK. Treatment of Congenital Nevomelanocytic Nevi with the CO2 and Q-Switched Alexandrite Lasers. Dermatol Surg 2006; 31:518-21. [PMID: 15962733 DOI: 10.1111/j.1524-4725.2005.31153] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Su Jean Chong
- Department of Dermatology, St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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21
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Efficacy and Safety of Short-Pulse Erbium. Dermatol Surg 2006. [DOI: 10.1097/00042728-200602000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Patients presenting with congenital melanocytic nevi (CMN) need individualized treatment based upon nevus size, thickness, location, risk for developing melanoma, and psychological characteristics of the patient and family. The present authors review CMN types and prognoses, as well as absolute and relative indications for treatment. Risks and benefits of several treatment options are discussed, including surgical options, such as excision, chemical peels, dermabrasion and curettage, and laser therapy. The main focus of treatment is, in all cases, to address the concern for developing melanoma, at the same time optimizing the aesthetic and functional outcomes.
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Affiliation(s)
- Jennifer Tromberg
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Pearson GD, Goodman M, Sadove AM. Congenital Nevus: The Indiana University??s Approach to Treatment. J Craniofac Surg 2005; 16:915-20. [PMID: 16192882 DOI: 10.1097/01.scs.0000181190.45113.72] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The article will review the different treatment modalities for congenital nevi and the senior author's approach to these lesions. The management of congenital melanocytic nevus presents a diagnostic dilemma. Treatment must weigh the risk of malignancy, psychological distress to parents and child, and potential morbidities of excision. Excision of every nevus is neither applicable nor practical. Most plastic surgeons would agree that a large nevus mandates excision because of the risk of malignancy. However, debates occur regarding treatment of small and medium size nevi. Opinions differ regarding the types of reconstruction, malignant potential, and psychological impact of leaving a lesion untreated.
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Kono T, Erçöçen AR, Nozaki M. Treatment of Congenital Melanocytic Nevi Using the Combined (Normal-Mode Plus Q-Switched) Ruby Laser in Asians. Ann Plast Surg 2005; 54:494-501. [PMID: 15838210 DOI: 10.1097/01.sap.0000154866.01964.8c] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Taro Kono
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan.
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Rosenbach A, Ram R. Treatment of Acanthosis Nigricans of the Axillae Using a Long-Pulsed (5-msec) Alexandrite Laser. Dermatol Surg 2004; 30:1158-60. [PMID: 15274711 DOI: 10.1111/j.1524-4725.2004.30346.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acanthosis nigricans of the axillae is a common cutaneous disorder that is difficult to treat. OBJECTIVE The objective was to assess the efficacy and safety of a long-pulsed alexandrite laser (5 msec) in the treatment of acanthosis nigricans of the axillae. METHODS A single axilla was treated using the long-pulsed alexandrite laser. Ten sessions were required, at fluences of 16 to 23 J/cm2 using either 10- or 12.5-mm spot sizes. The untreated axilla served as a control. RESULTS Greater than 95% clearance was achieved after seven sessions. There was no recurrence after 2 years. The untreated axilla was unchanged. CONCLUSIONS The long-pulsed alexandrite laser can effectively and safely treat acanthosis nigricans of the axillae.
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Affiliation(s)
- Alan Rosenbach
- 2080 Century Park East No. 1704, Los Angeles, CA 90067, USA.
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Treatment of Acanthosis Nigricans of the Axillae Using a Long-Pulsed (5-msec) Alexandrite Laser. Dermatol Surg 2004. [DOI: 10.1097/00042728-200408000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Suzanne L Kilmer
- Laser and Skin Surgery Center of Northern California, 3835 J Street, Sacramento, CA 95816, USA.
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Downs AMR, Rickard A, Palmer J. Laser treatment of benign pigmented lesions in children: effective long-term benefits of the Q-switched frequency-doubled Nd:YAG and long-pulsed alexandrite lasers. Pediatr Dermatol 2004; 21:88-90. [PMID: 14871338 DOI: 10.1111/j.0736-8046.2004.21122.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Michel JL. Is Laser Therapy an Adequate Treatment for Giant Congenital Melanocytic Nevi? ACTA ACUST UNITED AC 2004. [DOI: 10.1078/1615-1615-00119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kono T, Ercocen AR, Kikuchi Y, Isago T, Honda T, Nozaki M. A giant melanocytic nevus treated with combined use of normal mode ruby laser and Q-switched alexandrite laser. J Dermatol 2003; 30:538-42. [PMID: 12928544 DOI: 10.1111/j.1346-8138.2003.tb00429.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2002] [Accepted: 04/15/2003] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Taro Kono
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Tanzi EL, Lupton JR, Alster TS. Lasers in dermatology: four decades of progress. J Am Acad Dermatol 2003; 49:1-31; quiz 31-4. [PMID: 12833005 DOI: 10.1067/mjd.2003.582] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Elizabeth L Tanzi
- Washington Institute of Dermatologic Laser Surgery, Washington, DC 20037, USA
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Marghoob AA, Borrego JP, Halpern AC. Congenital melanocytic nevi: treatment modalities and management options. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2003; 22:21-32. [PMID: 12773011 DOI: 10.1053/sder.2003.50002] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Boixeda P, Pérez-Rodríguez A, Fernández-Lorente M, Arrazola JM. Novedades en láser cutáneo. ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)76675-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Westerhof W, Gamei M. Treatment of acquired junctional melanocytic naevi by Q-switched and normal mode ruby laser. Br J Dermatol 2003; 148:80-5. [PMID: 12534599 DOI: 10.1046/j.1365-2133.2003.05068.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- W Westerhof
- Netherlands Institute for Pigment Disorders and Department of Dermatology, IWO-Building/Academic Medical Centre, University of Amsterdam, Meibergdreef 35, The Netherlands.
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Abstract
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.
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Kono T, Erçöçen AR, Chan HHL, Kikuchi Y, Nozaki M. 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. Ann Plast Surg 2002; 49:476-85. [PMID: 12439014 DOI: 10.1097/00000637-200211000-00006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Taro Kono
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Japan
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Abstract
This article discusses the care of patients with CMN, who often require a multidisciplinary approach involving pediatricians, family physicians, internists, dermatologists, psychologists, plastic surgeons, neurologists, and radiologists. The cosmetic and psychosocial issues, combined with the knowledge of the increased risk of developing melanoma or NCM, is a huge burden that many of these patients and their families have to carry. This article describes the importance for physicians to help these patients and families come to terms with these issues, as well as remind their patients and their family members that although melanoma, NCM, or other complications can develop, most affected individuals do not develop any complications. The article mentions that there are many healthy, happy, functional adults with large, small, and multiple CMN alive today.
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Affiliation(s)
- Ashfaq A Marghoob
- Department of Medicine, Dermatology Division, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Abstract
There are few areas in dermatology that provoke as much controversy as dysplastic nevus. Over the past decade, there have been significant strides made in terms of understanding the biology and etiology of the lesion. Distinct and reliable clinical and histologic features have been delineated. In this article, the management of patients with dysplastic nevi and the role for dermoscopy, photographic surveillance, genetic mapping and counseling, chemoprevention, and nevi removal are discussed.
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Affiliation(s)
- Thomas G Salopek
- Division of Dermatology and Cutaneous Sciences, University of Alberta, 2-125 Clinical Sciences Building, Edmonton, Alberta, Canada, T6G 2G3.
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Clinical Application of Lasers in Asians. Dermatol Surg 2002. [DOI: 10.1097/00042728-200207000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
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.
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Affiliation(s)
- Henry H Chan
- Division of Dermatology, Department of Medicine, University of Hong Kong, Hong Kong, SAR.
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41
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Abstract
Laser treatment of pigmented lesions can be a rewarding experience when appropriate lesions are treated. Accurate diagnosis of pigmented lesions is needed before treatment. In some lesions, adjuvant topical therapy is greatly beneficial, and for others it may be the only option. The treatment of melanocytic nevi is controversial but worth pursuing. All tattoos respond well to Q-switched lasers; the appropriate wavelength depends on the color of ink. Amateur and traumatic tattoos clear readily with laser treatment. Cosmetic tattoos should be approached with caution. In addition, the use of laser-responsive ink and higher-powered or shorter-pulsed (picosecond) lasers may further enhance the ability to treat tattoos.
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Abstract
Laser skin surgery is not without risk and some degree of downtime in most situations. Patient satisfaction is key to the perceived success of the procedure. Therefore, the physician must fully explain all risks, potential complications, and expected morbidity associated with any laser treatment to be performed. Although many side effects can be avoided by use of appropriate intraoperative technique and adequate postoperative management, untoward effects may still occur and must be promptly identified and addressed. An informed patient is an important factor in the healing process and contributes to the success of the procedure.
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Affiliation(s)
- Elizabeth I McBurney
- Department of Dermatology, Louisiana State University Health Sciences Center, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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Abstract
UNLABELLED All authors agree upon the need for early treatment of giant congenital nevi. The surgeon must seek to minimize the risk of malignancy. The objective calls for radical excision of all pigmented areas; this may be impossible because of the risk of leaving the patient with disfiguring scars. The aim of this study was to assess treatment of giant congenital nevi with the high-energy pulsed CO2 laser as an alternative to surgery. PATIENTS AND METHODS Between 1998 and 1999, the high-energy pulsed CO2 laser was used in nine newborns and five children. RESULTS The treatment with the high-energy pulsed CO2 laser achieved 70-90% clearing of the giant nevi in most of the children. Two children developed hypertrophic scars on a companion nevi and on giant congenital nevi. One child required a skin graft because of tissue necrosis, associated with a disseminated intravascular coagulation and septic shock. DISCUSSION Laser is a surface technique proposed when surgical excision cannot be performed because the surface is too large or the localization is incompatible with surgery. Early treatment, in the first 15 days, is not required for the quality of the cosmetic result. The high-energy pulsed CO2 laser provides satisfactory cosmetic results with short cicatrisation time. It allows the treatment of the companion nevi at the same time. The risk of malignant transformation is greatly but not totally reduced. Regular clinical surveillance should help reduce the risk.
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Affiliation(s)
- J L Michel
- Service de dermatologie, hôpital Nord, centre hospitalier universitaire de Saint-Etienne, 42055 Saint-Etienne, France.
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Kono T, Nozaki M, Chan HH, Sasaki K, Kwon SG. Combined use of normal mode and Q-switched ruby lasers in the treatment of congenital melanocytic naevi. BRITISH JOURNAL OF PLASTIC SURGERY 2001; 54:640-3. [PMID: 11583505 DOI: 10.1054/bjps.2001.3688] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- T Kono
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Bjerring P, Christiansen K. Intense pulsed light source for treatment of small melanocytic nevi and solar lentigines. JOURNAL OF CUTANEOUS LASER THERAPY 2000; 2:177-81. [PMID: 11350673 DOI: 10.1080/146288300750163745] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The purpose of this clinical study was to evaluate the effectiveness of an intense pulsed light (IPL) irradiator system for the treatment of benign pigmented lesions. MATERIALS AND METHODS A total of 18 patients with lentigo solaris and eight patients with melanocytic nevi were treated once with an IPL system. After 2 months, the effect was evaluated on close-up photographs. RESULTS Pigment reduction was obtained in 96% of the patients, and the average clearance was found to be 74.2% and 66.3% for lentigo solaris and melanocytic nevi, respectively. CONCLUSION The IPL was found to be effective for removal of benign pigmented lesions.
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Affiliation(s)
- P Bjerring
- Department of Dermatology, Marselisborg Hospital, Univeristy Hospital of Aarhus, Denmark
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Kilmer SL, Garden JM. Laser treatment of pigmented lesions and tattoos. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2000; 19:232-44. [PMID: 11149604 DOI: 10.1053/sder.2000.18363] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Benign pigmented lesions and tattoos are often very responsive to laser treatment. The chromophore in most cases is melanin, although other endogenous and exogenous pigments can be targeted. The chromophore and its distribution in the skin, as well as the underlying biological processes, all help determine the best laser, if any, for a given pigmented lesion. Epidermal lesions respond well to shorter wavelengths (up to 755 nm), whereas for deeper lesions, 694 nm or longer are typically used. The 1,064-nm Nd:YAG laser is best for treating darker skinned individuals. Multicolored tattoos may need several wavelengths to best target individual ink colors.
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Affiliation(s)
- S L Kilmer
- Laser & Skin Surgery Center of Northern California and the University of California, Sacramento 95816, USA
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Abstract
This article reviews the current uses of lasers in dermatological practice. It outlines safety issues and legislation and attempts to summarize the relevant physics and light interactions. The article is divided into sections pertaining to selective photothermolysis of structures containing the major skin chromophores: haemoglobin, melanin and water. The lasers used and conditions treated are discussed with reference to a literature review.
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Affiliation(s)
- K M Acland
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Lambeth Palace Road, London SE1 7EH, UK
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Affiliation(s)
- M B Alora
- Wellman Laboratories of Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02144, USA
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50
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Marini L. Guest Editorial. JOURNAL OF CUTANEOUS LASER THERAPY 1999; 1:196. [PMID: 11360459 DOI: 10.1080/14628839950516661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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