A new approach for treatment of congenital melanocytic nevi with hypertrichosis: the Depilendolaser technique

Abstract

Congenital melanocytic nevi (CMN) are proliferations of cutaneous melanocytes which are present at birth or may develop during the first postnatal weeks. In 50% of the cases, hypertrichosis is also present. Lasers as CO2, normal mode ruby, Q-switched ruby, Q-switched alexandrite (755 nm) and Qswitched neodymium:yttrium-aluminium-garnet (Nd:YAG) 532 and 1064 nm can be used for the treatment of some CMN. There is a new technique of treatment for the congenital melanocytic nevi with hypertrichosis with a good improvement on reducing pigmentation and hypertrichosis. The authors describe their experience with a new laser technique for the depigmentation and the epilation of CMN with hypertrichosis: the Depilendolaser (Depigmentation Epilation, Endolaser) technique. In this procedure, CMN were treated with a subcutaneous approach by a LBO diode-pumped laser Quanta D - Quanta System S.p.A., Italy (wavelength = 532 nm) and with a cutaneous approach by Versapulse Select Lumenis® (wavelength = 532 nm). Histology was performed on CMN tissue samples. Over a 2-year period, 25 subjects were treated using Quanta D ® (wavelength = 532 nm) power 8 W, frequency 4.9 Hz and 0.48 J/60 ms pulse, through a 300-μm fibre optic for treatment from underneath the derma to the surface, and using the frequency-doubled Q-switched Nd:YAG laser (wavelength = 532 nm) Versapulse Select (Lumenis Ltd.,Yokneam, Israel) QS 532 nm, round spot size of 3 mm in diameter, fluence 2 J/cm2, energy 0.20 J/10 ms pulse and frequency 10 Hz, for the treatment from the surface to the depths. The Depilendolaser technique resulted to produce greater hair loss in the treated area with significant depigmentation and a relevant aesthetic improvement. Histopathological examination of the lesions after treatment, in comparison with non-treated areas of the same gigantic nevi, shows loss of pigmented melanocytic nests and hair follicles—often numerous and normotrophic in these congenital nevi—disappear after treatment with the new laser technique. The authors describe a new laser technique for depigmentation and epilation and their experience in the treatment of CMN with hypertrichosis. Data collected in this study showed first of all an extreme safety and tolerability of the procedure in children and young patients, with no adverse effects such as skin atrophy, pathological scarring and aesthetic improvement. Level of evidence: Level I, therapeutic; risk/prognostic study.