Laser treatment of congenital melanocytic naevi: a systematic review

Summary

Most people have a few brown spots on their skin known as melanocytic naevi or moles. Moles are harmless but can occasionally transform into a potentially lethal tumour called malignant melanoma. Congenital melanocytic nevi (CMN) are ones that are present at birth or develop in the first few weeks of life. Congenital nevi, in particular those that are large in size and on visible areas of skin, can be a great burden when people are unhappy with how they look. Moreover, there is an increased risk of developing malignant melanoma in patients with CMN, especially in the larger CMN. The lifetime risk of malignant melanoma in patients with CMN is thought to be about 0.7% to 2.9%. Surgically removing (excision of) the CMN to decrease the risk of melanoma has been a common treatment, however, this has not been proven to reduce the risk of melanoma. CMN can be too large to completely remove with excision, and excision can cause scarring. Therefore, in more recent years, other treatments have been explored, including the use of lasers to remove the CMN. This option is controversial, mainly because of the lack of evidence on efficacy, and safety concerns. Some state that lasers may reduce the risk of malignancy by decreasing the melanocytic mass while others are concerned about the potential cancer-causing risk of laser damage. The objective of this study from the Netherlands was to review the efficacy and safety of different laser types used for CMN. The researchers found that a great variety of laser devices and combinations of lasers have been used for treatment of congenital nevi. There is very low quality evidence that laser therapy in CMN is effective and safe in the short term, however there were high incidences of scarring, repigmentation (colour coming back) and complications. More high quality studies are required in order to really answer the question regarding efficacy and safety of laser treatment in CMN.