Treatment of Congenital Melanocytic Nevi With a Dual-Wavelengths Copper Vapor Laser: A Case Series

Abstract

Introduction: Congenital melanocytic nevus (CMN) is a severe challenge for dermatology. This pigmented skin lesion is undesirable for patients because of its localization in open areas of the body. Various visible and near-infrared laser systems and intense pulsed light (IPL) sources have been applied for CMN treatment. However, post-traumatic hyperpigmentation, structural changes, atrophy, and scarring due to non-specific thermal damage have been observed. Many patients have shown recurrence after treatment. Therefore, it highlights the need for testing new laser modalities for the management of CMN. Methods: Two adult II Fitzpatrick phototype patients (a 55-year-old male and a 30-year-old female) with middle-sized facial CMN (on the forehead and lower eyelid) are presented. All patients were treated with dual-wavelength copper vapor laser (CVL) radiation at 511 nm and 578 nm wavelengths with a power ratio of 3:2. The average power was 0.7-0.85 W with an exposure time of 0.3 seconds. The spot size amounted to 1 mm. Results: Both patients showed complete resolution of CMN after CVL treatments. CMN became crusted within a few days after the laser treatment and peeled off within seven days. No recurrences were observed during the follow-up period up to 24 months. Conclusion: The middle-sized CMN can be successfully treated with dual-wavelength CVL radiation.

Treatments of palpebral congenital melanocytic nevus: a systematic review

“…Few authors described better outcome by early treatment with laser in infancy 20,21 , but this and other studies could not conclude the same 22 .…”

“…Using the dual-wavelength, CVL is reasonable as the 511 and 578 nm wavelengths coincide with the melanin absorption wavelength and maximum oxyhemoglobin absorption wavelength, respectively. Adjacent tissue thermal damage can be minimized with adequate laser pulse duration, which does not exceed the target chromophore unit's thermal relaxation time 22 that depends on the size of the chromophore unit: less than 1 μs for isolated melanosomal cells of 7-μm size and 10 ms for cluster sizes of about 100 μm 24 . Vascularization increases by two folds according to optical coherence tomographic data in the CMN lesion 25 , promoting the use of 578-nm yellow CVL radiation to prevent recurrence by heating dysplastic vessels 26,27 .…”

Surgery or Not? A Systematic Review of Facial Congenital Melanocytic Nevi Treatment Patterns and Outcomes

“…After the removal of 210 duplicates and 160 irrelevant studies, 167 full-text articles were assessed for eligibility, of which 23 met inclusion criteria. The included studies were then cross-referenced and a further 11 studies met the inclusion criteria, totaling 34 included studies for thematic analysis 9–42 . Two additional identified studies did not explicitly report any outcome, aside from complications, and did not include any aesthetic-related information and were excluded 43,44 .…”

“…Within the included studies, 53% reported on a conservative treatment modality, 9,[13][14][15]18,19,[22][23][24][25][26]30,32,33,35,39,41,42 44% reported on surgical excision of FCMN, [10][11][12]16,17,20,21,[27][28][29]31,34,36,38,40 and 3% used a combined, surgical and conservative treatments. 37 Following surgical excision, 27% of studies reported reconstruction using a flap, and 21% used a full-thickness skin graft (FTSG).…”

The Emerging Role of Visible Light in Melanocyte Biology and Skin Pigmentary Disorders: Friend or Foe?

“…Another type of laser that is highly specific for vascular lesions is copper vapor laser, emitting a dual wavelength comprising 10% 511 nm and 90% 578 nm, which is at the proximity of the absorption peak of hemoglobin [108]. Nonetheless, the dualwavelength copper vapor laser shows great efficacy in eliminating congenital melanocytic nevi (CMN) [109], yet demonstrates less efficacy in treating melasma patients [108,110], except for those with pronounced vascular abnormality [111].…”