Laser treatment of congenital melanocytic naevi: a systematic review

Recent studies on congenital melanocytic naevi (CMN) indicate a lower risk of melanoma than has been previously assumed. As a result, the treatment paradigm in CMN has shifted from complete removal to cosmetically acceptable, less invasive treatment options, such as laser treatment. Our objective was to review systematically the efficacy and safety of laser therapy for CMN. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and PubMed. We rated the quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-four eligible studies (three nonrandomized controlled studies; 21 case series) with 434 patients were included; the majority were 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. Owing to heterogeneity between studies, comparison between laser modalities was hampered and statistical analysis was precluded. Lasers in CMN showed rather good results (albeit with very low-quality evidence) for clearing of hyperpigmentation in the short term. Outcome measures varied widely, patient satisfaction was rarely 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 in the long term. Future research should focus on well-conducted and well-reported prospective studies on different laser modalities for CMN, with the use of recognized and validated outcome measures. What's already known about this topic? Congenital naevi may have a great impact on quality of life owing to their cosmetic appearance. Excision, the gold-standard treatment, is not always possible or desired; other treatment options, such as laser treatment, should be explored. Laser treatment of congenital naevi is controversial, owing to varying results and unknown effect on malignancy risk. What does this study add? A great variety of laser devices and combination of lasers have been used for treatment of congenital naevi. Laser treatment shows good results in short-term clearance of pigmentation in congenital naevi, but there is a high incidence of scarring, repigmentation and complications (albeit with very-low-quality evidence). Well-conducted and well-reported prospective studies with the use of recognized and validated outcome measures are warranted. Plain language summary available online