Failure of Q-switched ruby laser to eradicate atypical-appearing solar lentigo: report of two cases

Cutaneous lasers, including argon, Q-switched Nd:YAG, Q-switched ruby, Q-switched alexandrite, and short pulsed dye lasers, have been used to treat solar lentigines and other benign melanocytic lesions. However, the effects of these lasers at standard fluences on atypical melanocytic lesions have not been examined. We describe two patients in whom the Q-switched ruby laser failed to successfully treat clinically atypical-appearing solar lentigines. In both, clinically atypical-appearing melanocytic lesions were treated with excellent initial cosmetic results. In the first patient, the pigmentation returned several months after treatment and continued to increase in size and color. A biopsy specimen 30 months after Q-switched ruby laser therapy revealed a lentigo maligna melanoma. In the second patient, the lesion recurred 6 months after Q-switched ruby laser therapy, and a biopsy specimen 1 year after treatment showed an early lentigo maligna. Thus Q-switched ruby lasers and other cutaneous lasers capable of targeting melanin may be inadequate to eliminate lentigo maligna and other atypical melanocytic lesions completely. These cases emphasize the importance of careful clinical assessment before any laser surgery and the need to advise patients to return for evaluation should pigmentation return.