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

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.

Retrospective photographic review of nontattoo indications treated by picosecond laser

BACKGROUND

Picosecond (PS) lasers were approved by the US FDA in 2012 after being shown to remove tattoos with more success and fewer treatments compared with traditional methods. PS lasers were shown to be versatile, indicated for the treatment of lentigines, café-au-lait macules (CALMs), and acne scars and skin rejuvenation.

OBJECTIVE

We report our experience treating our patients for different indications using a PS laser.

METHODS

We performed a retrospective chart and photographic review of all patients seen between 2016 and 2018 that were treated in our centers with a PS laser for nontattoo indications. Clinical outcomes were evaluated using side-by-side comparisons of the clinical photographs by two blinded, independent physicians using a visual analog scale consisting of six levels of treatment response.

RESULTS

A total of 233 patients were studied. Most sought treatment for solar lentigo (27%) and skin rejuvenation (14%). Epidermal nevi exhibited the greatest improvement with treatment, while acne scarring demonstrated the least. Only 24% of patients experienced noteworthy, transient adverse effects.

CONCLUSION

Picosecond lasers were efficacious and safe for a variety of indications. They were effective in treating epidermal nevi and pigmented lesions, such as Lentigines and CALMs.

Complete regression of a melanocytic nevus after epilation with diode laser therapy

The use of lasers and intense pulsed light (IPL) technology has become an established practice in dermatology and aesthetic medicine. The use of laser therapy and IPL in the treatment of pigmented melanocytic lesions is a controversial issue. We report clinical, dermoscopic and histological changes of a completely regressed pigmented melanocytic nevus after hair removal treatment with the LightSheer™ Diode Laser (Lumenis Ltd, Yokneam, Israel).

Lasers for nevi: a review

A nevus is described as a benign, often pigmented, skin growth that can be congenital or acquired. Different types of nevi are located at different depths within the skin. Traditional treatments for nevi include topical treatments, dermabrasion, and excision, which are generally ineffective, invasive, and often result in scars and dyspigmentation. Lately, laser therapy has been used as an alternative. Based on the theory of selective photothermolysis, melanin can be specifically targeted, minimizing adverse effects and increasing effectiveness of laser treatments. Several types of lasers and lights have been studied for this purpose without a concise agreement as to which is the best. In general, quality-switched lasers are preferred for the treatment of pigmented lesions. However, there is controversy about this therapy because certain nevi may have malignant potential. This article serves as a comprehensive review of available laser treatments for nevi and discusses the appropriate measures that should be taken before and after laser therapy. Based on the reviewed literature, laser treatment has generally been proven to be a safe and effective therapy for nevi with minimal side effects.

Optimal management of common acquired melanocytic nevi (moles): current perspectives

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.

Laser removal of pigmented and vascular lesions

Twenty years of laser dermatology has resulted in current technology which allows variable spot sizes, different wavelengths, and a variety of effective cooling devices. These developments have made the treatment of cutaneous pigmented and vascular lesions safe and efficacious by targeting selected chromophores while minimizing damage to the surrounding tissue. Vascular lesions are targeted by a variety of wavelength lasers including the KTP (532 nm), pulsed dye (585-595 nm), and the Nd:YAG (1064 nm) laser systems. Pigmented lesions may be treated with a wide variety of lasers due to the broad absorption spectrum of melanin. Intense pulsed light (IPL), with its widely adjustable parameters, has established itself as a useful adjunctive for the treatment of a variety of pigmented and vascular lesions. The purpose of this review article is to present the current treatment options for the common aesthetic complaints of pigmented and vascular lesions.

Efficacy and safety of the short-pulse erbium:YAG laser in the treatment of acquired melanocytic nevi

BACKGROUND

Various laser systems have been used in the treatment of acquired melanocytic nevi. However, CO2 lasers may cause scarring, and some nevi cannot be removed with pigment-specific lasers completely. To date, no study has evaluated the efficacy and safety of an erbium:yttrium-aluminum-garnet (YAG) laser, with its small penetration depth and fewer adverse effects, in the treatment of acquired melanocytic nevi.

OBJECTIVE

To investigate the efficacy and safety of the short-pulse erbium:YAG laser in the treatment of acquired melanocytic nevi.

METHODS

The study included 28 nevi in 14 patients. The lesions were pigmented, flat, or just palpable nevi. Nevi were irradiated with single-pulse laser energy of 1,000 mJ and a pulse duration of 300 microseconds. Fluences between 5.2 and 14.4 J/cm2 were used. Four months following laser treatment, the entire lesion was excised. Each specimen was histopathologically and immunohistochemically examined for the presence of nevus cells.

RESULTS

Clinically, all of the nevi and, histopathologically, 27 of 28 nevi (96%) were completely removed without scarring. Post-inflammatory hyperpigmentation was seen in two patients and hypopigmentation in three patients.

CONCLUSIONS

Short-pulse erbium:YAG laser treatment is an effective and safe method for removing acquired melanocytic nevi.