Treatment of medium-sized facial nevus spilus with a dual-wavelength copper vapor laser

Abstract

Nevus spilus (NS; synonym: speckled lentiginous nevus) − benign congenital or, more often, acquired melanocytic nevus − is characterized by numerous foci of hyperpigmentation located on a light brown background with possible transformation into malignant tumors. Its prevalence is ∼2% among the general population. NS sizes vary from 2 to 10 cm in diameter, but more extensive lesions have been described. Patients turn to a dermatologist when NS is located in aesthetically significant areas owing to cosmetic problems. Surgical methods for removing NS are associated with a risk of scarring. The use of various types of lasers for the treatment of NS has allowed successful results. However, it is accompanied by adverse effects such as scars, postinflammatory hyperpigmentation, and relapses. Our experience in treating benign melanocytic skin lesions using copper vapor laser (CVL) radiation, which allows selective heating of the pigment and blood vessels, gives us grounds for using CVL to treat NS. For the first time, we describe an innovative method of treating NS with dual-wavelength CVL radiation. A case of NS (medium size 50×40 mm) located in the cheek area was treated in a 39-year-old fair-skinned patient with type II skin, according to Fitzpatrick. NS treatment was carried out with the following parameters of the CVL (Yakhroma-Med model, P.N. Lebedev Physical Institute of the Russian Academy of Sciences): average power 0.6–0.8 W, with a power ratio of 3:2, at wavelengths of 511 and 578 nm. The pulse duration is 20 ns, the repetition rate is 16.6 kHz, the exposure time is 0.2–0.3 s, and the diameter of the light spot on the skin is 1 mm. After six treatments, the color of the hyperpigmented area, dark macules, and papules were eliminated. The follow-up period was 24 months. Medium-sized NS treatment with CVL provided complete elimination of the pathological focus and provided excellent cosmetic results. No relapse was observed within 24 months after treatment.