Carbon Dioxide Laser Dermabrasion for Giant Congenital Melanocytic Nevi

Abstract

The management of giant congenital melanocytic nevi remains controversial. There is a balance to be achieved between minimizing the disfiguring appearance of these lesions, both before and after surgical treatment, and limiting the risk of malignant change. A series of seven patients who were treated in the same manner, with carbon dioxide laser dermabrasion, is presented. It has been 6 years since the first patient was treated in this way, and no cases of recurrence have been observed. This technique enables the removal of all or most of the pigmented lesion, with minimal scarring and without the need for disfiguring skin grafts. It has been well proved that there is an increased risk of malignant changes among patients with these lesions, although the amount of increased risk for the patient is not clear. Evidence from a review of the currently available literature is presented to indicate why this management method, at best, should decrease this risk and, at worst, should make no difference to the overall risk for individual patients.

Congenital giant nevocellular nevus of the back with deep extension to the fat and fascia

“…Factors often associated with the risk of malignant degeneration include location of the lesion, presence of neurocutaneous melanocytosis, and depth and distribution of the pigmentation. However, the risk of malignancy seems to be lower than previously reported, now expressed as a life-risk range of 2.3%, with most cases tending to occur before adolescence (1)(2)(3)(4)(5)(6)(7).…”

“…When the decision is made to proceed with some form of treatment, greater attention should be paid to achieving a more functional and aesthetic result, because the excision based only on oncological anticipation is no longer acceptable (7,18,35). The presence of deep pigmentation as exemplified here may reduce the effectiveness of treatment options other than surgical excision.…”

“…The carbon dioxide laser, the Er:YAG and the Q-switched ruby laser have all been recently used for resurfacing and to selectively treat deep pigmentation (32)(33)(34). The Q-switched ruby laser has been shown to have a potent effect on depigmentation, which could be used to lighten deep layers where resurfacing lasers are ineffective.…”

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

“…In particular, the Er:YAG laser is precise and it can be used for controlled resurfacing. It causes significantly less deep thermal injury, there is a shorter re-epithelialization time and it is less painful compared with the CO2 laser 20,23 . But it is only effective with respect to the upper levels of the dermis and multiple treatments at variable intervals can be required for achieving a cosmetically satisfactory outcome.…”

“…On the other hand, laser treatment is useful for large-sized CMNs, it is effective for cosmetically sensitive areas and it is safe for children 14 . The lasers used for the treatment of CMN include pigment-specific lasers [15][16][17][18][19] , resurfacing lasers [20][21][22][23] and a combination of the two 14,17,24,25 . In particular, the Er:YAG laser is precise and it can be used for controlled resurfacing.…”