Jurnal

“Laser pada Naevi”

Aji Prasetyo
Pembimbing:
dr. Betha Egih Riestiano Sp.BP-RE
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 P URP OSE

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 Purpose

The objective of this paper is to review

systematically the efficacy and safety of different
laser modalities used for CMN.

Compared aesthetic outcomes of the lasers

treatment.

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 MET HODS

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Methods

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)

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 Outcome Assessment
Our prespecified outcomes were:
(i) Physician global assessment (PGA);
(ii) Clearing of hyperpigmentation;
(iii) Improvement of hypertrichosis;
(iv) Repigmentation;
(v) Dyspigmentation;
(vi) Scarring;
(vii) Complications related to the procedure;
(viii) Patient satisfaction;
(ix) Histological atypia; and
(x) Clinical cutaneous malignancy.

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 Quality-switched laser

The QS laser was studied most often, with 135 patients QS lasers
showed good short-term clearing of hyperpigmentation; however, long-term
outcome was poor owing to repigmentation. The incidence of other adverse
effects (scarring, dyspigmentation) was low (0% and 1,4%, respectively).
Many treatments were needed to reach the end point (mean number of
sessions 3,9–18,7)

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Normal-mode laser
▫ The NM laser alone was used in 40 cases; The NM lasers showed the
lowest clearing of hyperpigmentation.

Normal-mode combined with quality-switched laser

▫ Seven studies evaluated combined NM and QS laser treatment in 84
patients. Repigmentation and high clearing of hyperpigmentation were
similar to QS lasers.

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 Ablative laser

▫ Five studies involving 45 patients used the carbon dioxide (CO2) laser,
whereas one study of 10 patients used the erbium-doped yttrium
aluminium garnet (Er:YAG) laser. These laser modalities had the
highest complication rates related to the procedure (mainly wound
infection – very serious in one patient) 33 and the highest occurrence of
scarring (25%), reaching 50% in a study using a continuous-wave CO2
laser

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 Ablative laser combined with quality-switched laser
▫ The CO2 laser was combined with a QS laser of 109 patients. This
combination showed high clearance of hyperpigmentation in both the
short and long term. Repigmentation seemed less than with pigment
lasers alone, and no permanent dyspigmentation was reported. No
permanent scarring was seen; transient scarring was reported in 8%.

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 Ablative laser combined with normal-mode laser

▫ The combination of ablative and NM laser was studied in 11

patients. Clearing of hyperpigmentation in the short term seemed
excellent, with repigmentation seen in about 20% of patients after
3–6 months and no permanent scarring

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 RE SULT

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 Results
Sized of CNM treated with laser

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 Results for Aesthetical Items

• Scarring was often seen in large-to-giant CMN treated with ablative lasers (as high as 25%).
• More scarring was seen with the continuous-wave and low-energy pulsed CO2 lasers than
with the high-energy, ultra-short pulsed CO2 lasers. Hypothetically, the shorter pulse
duration limits thermal conduction and thereby spares surrounding tissue
• The Er:YAG laser could be a safer alternative to the CO2 laser when using an blative laser
as it results in less thermal damage and faster wound healing.
• The risk of scarring was negligible with use of the pigment lasers alone, which is to be
expected owing to its target-specific mode of action. A recent review also showed that laser
therapy might improve the cosmetic appearance of CMN, although repigmentation, and
complications such as hypertrophic scarring and hypopigmentation were also reported.

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 Complication
• Complications related to the procedure were only reported in ablative lasers (wound
infection in 18%), but in many studies this was not addressed.
• There is concern for melanoma as some case reports of melanoma after laser treatment in
pigmented lesions have been published.48–50 However, it is not certain whether the lesions
were misdiagnosed before treatment or if they were actually caused by the laser.
• The potential risk of transformation of naevus cells to melanoma following incomplete
eradication after laser therapy in CMN has still not been established

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 Disc ussio n
&
Conclusion

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 Discussion

• We systematically reviewed 24 studies with 20 different types of laser treatments in 434

patients to examine the efficacy and safety of the lasers. Overall, the QS laser was the most
frequently used device, although large and giant CMN were generally treated with an
ablative laser. Lasers in CMN showed good results for short-termclearance of
hyperpigmentation, but the quality of evidence is very low. High incidences of
repigmentation, scarring and other complications were reported.
• Results on clearing of hyperpigmentation were mainly good to excellent (> 50% clearing) in
all laser categories, measured directly up to 25 years after laser treatment. The best results
were achieved with combined ablative and pigment laser therapy. Repigmentation was
reported in up to 54% of patients, mainly with the use of pigment lasers. Repigmentation
was measured in both the short (3–6 months) and long term (25–16 years) in all the laser
categories, except for combined ablative and NM laser therapy (only short term

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Conclusion

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