Combination Laser Treatment in Procedural Management of Congenital Melanocytic Nevi

Congenital melanocytic nevi (CMN) are benign melanocytic proliferations present at birth. Surgical excision has traditionally been the first-line management for CMN removal; however, it may result in scars and potential disfigurement. Multiple clinical studies have demonstrated the effects of laser treatment for CMN, but data on fair-skinned subjects remain limited.

To report the outcomes of combination laser therapy for CMN in pediatric patients.

A retrospective review was conducted on the electronic medical records of patients under 18 years of age with CMN of any size who underwent an operating room procedure at Massachusetts General Hospital between January 1, 2010, and December 31, 2022. Laser types and settings were determined by the treating physician. The age, gender, race, Fitzpatrick skin type, size of nevus, treated area, number of treatments, interval between sessions, laser device, treatment response, complication, and follow-up duration were collected.

Of 158 children with CMN, 13 were treated with laser therapy alone. Most patients had Fitzpatrick skin type I-III and large-to-giant CMN with facial involvement. They were typically treated with a combination of a long-pulsed laser and a Q-switched laser, followed by a resurfacing laser. The median number of total treatments was 7. The laser treatment achieved pigment reduction in all patients as expected, with no disfiguring scarring, unsatisfactory dyspigmentation, or adverse events observed during follow-up visits.

We conclude that CMN in children with lighter skin types can be effectively treated using a strategic combination of different laser devices over multiple sessions for cosmetic purposes.