A Combination of Dual-mode 2,940 nm Er:YAG Laser Ablation with Surgical Excision for Treating Medium-sized Congenital Melanocytic Nevus

Abstract

Background: There are various treatment options for congenital melanocytic nevus (CMN), including surgical excision, dermabrasions, curettage, laser treatment, chemical peels and cryosurgery. The proper choice of treatment depends on the size, location, thickness and clinical appearance of the nevi, the risk for developing melanoma, the psychological effect and the cosmetic component. Objective: The purpose of this study is to evaluate the outcome of a combination of surgical excision with Er: YAG laser ablation for treating CMNs. Methods: A total of 13 patients were included in this study. The nevus was excised as much as possible and only dermal suturing was performed, without epidermal suturing, for the primary closure. We then ablated the whole lesion, including the suture lines, by using a dual-mode 2,940 nm Er:YAG laser with three to five passes. All the lesions were followed up for 6 months and they were evaluated with respect to the healing status, infection, erythema, scarring, textural change and pigmentary change. Subject satisfaction was scored at the 16 th week by the patients. Results: Eleven (83%) of the 13 patients were clinically rated as having a good to excellent result by the physicians' Global Assessment Scale (GAS) scores for the lesions' reduction of size, the degree of scarring and the pigmentary change with only a one stage procedure. 10 (77%) of the total 13 patients reported a good to excellent result at four months after treatment. Conclusion: A combination of surgical excision with Er:YAG laser ablation as a one stage procedure is a safe, effective modality and it should be considered as one of the options for treating medium-sized CMNs.

Final congenital melanocytic naevi colour is determined by normal skin colour and unaltered by superficial removal techniques: a longitudinal study

“…Furthermore, medical complication rates were high, with reported scarring in up to 25%, and wound infection in up to 18% . Several small studies have reported dramatic improvements and high levels of patient satisfaction after superficial removal techniques; however, improvements in colour were judged subjectively and immediately postintervention . Furthermore, several reports and studies still advocate early aggressive intervention in CMN with superficial removal techniques with outcomes reported by direct comparison of results to early postnatal pictures .…”

“…1 Several small studies have reported dramatic improvements and high levels of patient satisfaction after superficial removal techniques; however, improvements in colour were judged subjectively and immediately postintervention. 5,[35][36][37][38][39][40][41] Furthermore, several reports and studies still advocate early aggressive intervention in CMN with superficial removal techniques with outcomes reported by direct comparison of results to early postnatal pictures. 3,5,[38][39][40][41][42] The striking images here of children in which untreated and treated areas of CMN end up at exactly the same final colour, should bring a halt to superficial removal of CMN as a method for lightening colour.…”

A retrospective analysis of Er: YAG laser treatment in solar lentigines: Our clinical observations

“…Since the thermal damage caused by Er: YAG lasers are more superficial than that of other ablative laser systems, Er: YAG laser treatment requires a shorter reepithelization time and is a less painful procedure. [18] In this study, the results of solar lentigo patients who were treated with Er: YAG were examined. Thirteen of fourteen patients showed good and excellent recovery.…”

Congenital melanocytic nevi: Where are we now?

“…Efficacy in terms of skin lightening appeared to be similar. Lim et al 82 reported results from a retrospective study of 13 patients treated with excision of as much of the lesion as possible followed immediately by treatment with a dual-mode, 2940-nm Er:YAG laser to the remaining nevus. After 6 months of follow-up, 83% of patients were rated as having good to excellent results.…”