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.

Keywords: 2,940 nm Er:YAG; Combined treatment; Congenital melanocytic nevus; Laser ablation; Surgical excision.

Fig. 1

Congenital melanocytic nevi before (A~F) and after treatment (G~L) with a combination of surgical excision and Er:YAG laser ablation (A, G, excellent/excellent; B, H, excellent/excellent; C, I, excellent/excellent; D, J, good/excellent; E, K, excellent/excellent; F, L, excellent/excellent. Global Assessment Scale (GAS) scores by the physicians/GAS scores by the patients).

Fig. 2

Global Assessment Scale (GAS) scores by the physicians and patients at 16 weeks after treatment.

Fig. 3

Assessment by physicians for erythema, the pigmentary changes and hypertrophic scarring at 16 weeks after treatment.