Laser treatment of congenital melanocytic nevi: a systematic review

Summary

Recent studies on congenital melanocytic nevi (CMN) indicate a lower risk for melanoma than assumed for many years. As a result, the treatment paradigm in CMN shifted from complete removal to cosmetically acceptable, less invasive treatment options such as laser treatment. Our objective was to systematically review the efficacy and safety of laser therapy for CMN. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed. We rated the quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-four eligible studies with 434 patients were included, three non-randomised controlled studies and 21 case series (majority of poor quality). Twenty different laser modalities or combinations were evaluated. Overall, the Q-switched laser was used most frequently, although large or giant CMN were generally treated with an ablative laser. Due to heterogeneity between studies, comparison between laser modalities was hampered and statistical analysis was precluded. Lasers in CMN showed rather good results for clearing of hyperpigmentation on the short term, albeit very low quality evidence. Outcome measures varied widely, patient satisfaction was hardly measured and high incidences of scarring, repigmentation and complications were reported. No malignant change was seen. While most studies report short-term improvement of CMN after laser therapy, there is no high quality evidence for the efficacy and safety of laser modalities in CMN on the long term. Future research should focus on well-conducted, and well-reported prospective studies on different laser modalities for CMN, with use of recognised and validated outcome measures.

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