Treatment of Congenital Nevi with Ruby and Alexandrite Lasers

Abstract

Introduction: Laser treatment of congenital nevi, especially large nevi, is controversial. Currently, the standard of care is treatment by surgical excision, which can lead to scarring and permanent hypopigmentation. Furthermore, excision of giant congenital nevi might involve a substantial body surface area and could require multiple excisions, resulting in multiple scars. Additionally, some nevi are in cosmetically sensitive anatomic locations where surgical excision could compromise function or leave cosmetically unacceptable scars. Materials and Methods: Seventeen patients with small to giant nevi of different sizes were treated with ruby and/or alexandrite lasers either in the same or different treatment sessions at 3–8-week intervals. Baseline biopsies of giant and some medium congenital nevi were obtained. All the nevi treated were histologically benign. In treating the two giant congenital nevi, the maximum effective fluences were determined through histological examination of treated anatomic locations after treatment at different energy levels. Results: Two small nevi (12%) completely cleared and 12 small and medium nevi (71%) showed partial or cosmetically acceptable response. The two giant congenital nevi achieved 50–75% lightening after 6 or 7 treatment sessions. Side effects were minimal in most patients and included crusting and purpura immediately postoperatively. More severe hemorrhagic reaction and superficial thermal necrosis resulting in several patches of scar tissue 1–2 cm in width was seen in one of the two patients with giant congenital nevi. The hypertrophic scarring was effectively treated with pulse dye laser and intralesional Kenalog and 5-FU. Histological examination of the treated giant congenital nevi showed elimination of nevus cells in the upper dermis without appreciable fibrosis. Discussion: The ruby and alexandrite lasers are effective in partial or complete elimination of small nevi and lightening of medium to giant congenital nevi. Treatment of the giant congenital nevi requires dedicated patients, as well as persistence and diligence on the part of the treating physician. The risks and benefits should always be weighed before starting a course of treatment.