Changes in melanocytic nevi after laser treatment evaluated by dermoscopy and reflectance confocal microscopy

Franco, Ana Pampín; Villegas, Reyes Gamo; Muruzábal, Uxúa Floristán; Armada, Lucía Ascanio; Pinedo, Fernando; López-Estebaranz, J.L.

doi:10.1111/ijd.13083

Cited by 10 publications

(20 citation statements)

References 8 publications

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“…Histologic changes included mild atypia, thermal damage, scar formation, and partial or complete regression. 4,[11][12][13][14][15] Although some of the clinical and dermoscopic alterations may be concerning for malignancy, there were no nevi with malignant transformation following LHR. Moreover, none of the observational studies reported changes concerning for malignancy that warranted a skin biopsy.…”

Section: Resultsmentioning

confidence: 94%

“…16,17 Regression, asymmetry, gray areas, and loss of pigment network were alterations reported in multiple cases. 4,10,11,[13][14][15] Nasimi et al 17 found a significant correlation between changes in color and in size, while asymmetry was correlated to changes in size only. Histologic changes included mild atypia, thermal damage, scar formation, and partial or complete regression.…”

Section: Resultsmentioning

confidence: 99%

“…In comparison, 9 of 11 patient cases resulted in biopsy of at least one lesion of concern, and showed a variety of findings including subepidermal blister, increased melanophages, mild atypia, architectural changes, regression, and scar formation, however, notably no severe atypia or changes concerning for malignancy were noted. 4,[10][11][12][13][14][15]…”

Section: Resultsmentioning

confidence: 99%

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Changes in melanocytic nevi treated with laser hair removal: A systematic review

2023

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BackgroundIncidental treatment of melanocytic nevi during laser hair removal (LHR) has been noted to cause clinical and dermoscopic changes that may appear similar to findings seen in atypical or neoplastic melanocytic lesions. The rate and characteristics of these changes has not been well‐studied.ObjectivesThe objective of this review article is to assess the literature for reported changes in melanocytic nevi following LHR to guide clinical practice.MethodsPubMed was searched December 5, 2022 for articles evaluating changes in melanocytic nevi after LHR treatment using the following search terms: “nevi laser hair removal,” “nevi diode,” “nevi long pulse alexandrite,” “nevi long pulse neodymium doped yttrium aluminum garnet,” and “melanoma laser hair removal.” All English language patient‐based reports discussing incidental treatment of melanocytic nevi while undergoing LHR with a laser were eligible for inclusion, while reports of changes following hair removal with non‐laser devices such as intense pulsed light were excluded. Studies evaluating non‐melanocytic nevi such as Becker's nevus or nevus of Ota were excluded as were those evaluating the intentional ablation or removal of melanocytic lesions.ResultsTen relevant studies were included, consisting of seven case reports or series and three observational trials, two of which were prospective and one retrospective. Among the seven case reports or series there were a total of 11 patients, six of which had multiple affected nevi. Clinical and dermoscopic changes to nevi following LHR appear to be common in clinical practice, though not well studied. Clinical and dermoscopic changes have been noted to present as early as 15 days after treatment and persist to the maximum time of follow up at 3 years. Commonly reported changes include regression, decreased size, laser induced asymmetry, bleaching, darkening, and altered pattern on dermoscopy. Histologic changes include mild atypia, thermal damage, scar formation, and regression. Although some of the clinical and dermoscopic alterations may be concerning for malignancy, to our knowledge, there are no documented cases of malignant transformation of nevi following treatment with LHR.LimitationsThis study is limited by the low number of relevant reports and their generally small sample size, many of which is limited to single cases. Additionally, comparison of available data was limited by variable reporting of treatment regimens and outcomes.ConclusionsChanges to nevi treated during LHR are not uncommon. Modifications to nevi may occur and look similar to changes seen in dysplastic or neoplastic melanocytic lesions. Notably, despite the widespread use of LHR since the first device was Food and Drug Administration approved in 1995, a time span of nearly three decades, there have been no reported cases of melanoma or severe dysplastic changes within treated nevi. However, dermatologists should be aware that morphologic and dermoscopic alterations can occur after LHR to prevent unnecessary surgical procedures. Although melanoma has not been reported to occur in nevi treated with LHR nor with any other laser exposures, further long‐term data is needed to fully elucidate this concern. Optimally, nevi should be examined by a dermatologist before LHR to determine a baseline clinical and dermoscopic morphology. If there is concern for potential atypia, laser should be avoided over such nevi to avoid confusion at future follow up visits.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Changes in melanocytic nevi treated with laser hair removal: A systematic review

2023

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“…Several dermoscopic changes have been described in melanocytic nevi after LHR, including new blue and white structures, 6 new grayish areas in nevi that previously had homogeneous brown pattern, 3 loss of color (“bleaching”), regression (partial or complete), 7 blotches of brownish pigment without any pattern of melanocytic lesion, 8 increased pigmentation at the periphery, residual island of pigmentation, vanishing borders, acute burn with crusting, white structureless areas, and gray‐blue globules 9 . Occasionally, these changes can mimic melanoma, prompting an immediate excision.…”

Section: Introductionmentioning

confidence: 99%

Clinical and dermoscopic evaluation of melanocytic nevi changes during diode laser hair removal: A prospective study

et al. 2022

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Background Laser hair removal (LHR) is a common practice with increasing use worldwide. Clinical and dermoscopic changes in melanocytic nevi after LHR have been reported but prospective studies are lacking. Objective To describe dermoscopic changes of melanocytic nevi at different time points after LHR. Methods Prospective study in a cohort of female patients undergoing diode LHR. Dermoscopic follow‐up of at least three nevi on the legs that underwent hair removal. We included three nonexposed nevi on the arms as controls. Two blinded investigators analyzed dermoscopic images, according to variables selected based on the available literature. Results Thirty‐four patients were included with a total of 148 nevi on the legs and 112 nevi on the arms (controls). 47.9% (71/148) of the nevi on the legs had evidence of dermoscopic changes at the sixth hair removal session, compared to 9.8% (11/112) on controls (p < 0.001). The most frequent change was “bleaching” (41.9%, 62/148). Also, we observed “irregular hyperpigmented areas,” and “regression structures” in 5.4% (8/148) and 4.7% (7/148) of the cases at the sixth session, respectively. Neither of these structures were observed in the controls (p < 0.05). Limitations Only females were included; we did not perform histopathological evaluation nor reflectance confocal microscopy of changing nevi. Conclusion Melanocytic nevi frequently change after diode LHR. The changes cannot always distinguish between LHR induced and melanoma, so we advise avoiding nevi during laser therapies with melanin targets.

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“…RCM can also help distinguish benign lesions that have altered clinical or dermoscopic morphologies after undergoing prior laser or light treatment. Franco et al describe the development of blue‐white dermoscopic features in benign melanocytic lesions treated with intense pulsed light. Blue‐white structures, such as veils and globules, are common in melanoma as well as certain nonmelanoma skin cancers and the appearance of such structures could lead to unnecessary excisions of otherwise benign lesions.…”

Section: Introductionmentioning

confidence: 99%

Nevi and lasers: Practical considerations

Rogers

Krakowski²,

Marino

et al. 2017

Lasers Surg Med

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Lasers are increasingly used for elective ablation of melanocytic nevi (MN). However, the associated risks of treating MN with lasers are debated and not well studied. Theoretical risks include inadvertently treating a melanoma mistaken for a nevus, the inability to remove all nevus cells and the possibility for residual cells to undergo malignant transformation, and the difficulty in clinically monitoring the remnant nevus for melanoma progression. Additional concerns include the morphological suitability of a lesion for laser removal and managing patients' expectations about the variable cosmetic outcomes. These potential issues have prompted us to outline some practical suggestions for clinicians and patients to consider when determining the suitability of a nevus for laser ablation. The choice to perform laser removal of a nevus is personal, both from the perspective of the treating physician and that of the person being treated. While acknowledging some uncertainty, we believe that these suggestions can help mitigate risk and improve patient outcomes. Lasers Surg. Med. 50:7-9, 2018.

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Changes in melanocytic nevi after laser treatment evaluated by dermoscopy and reflectance confocal microscopy

Cited by 10 publications

References 8 publications

Changes in melanocytic nevi treated with laser hair removal: A systematic review

Changes in melanocytic nevi treated with laser hair removal: A systematic review

Clinical and dermoscopic evaluation of melanocytic nevi changes during diode laser hair removal: A prospective study

Nevi and lasers: Practical considerations

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