Objective: Treatment of congenital melanocytic nevi (CMN) with either the Q-switched (ruby, alexandrite, and Nd:YAG) lasers or the normal-mode ruby laser (NMRL) have been well established by many investigators, although there have been no consensus on the treatment of CMN. Recently, we developed a combined laser approach for treatment of CMN using both NMRL and Q-switched alexandrite laser. We present the procedure and efficacy of this combined laser treatment on giant CMN. Case Report: A2 year-old girl presented a dark-brown, giant CMN on her back, measuring 13x11 cm in size. Histological examination revealed a superficial compound nevus with no evidence of malignancy. The patient was treated first with the NMRL (694 nm wavelength, 18 J/cm2 energy fluence, 1 msec pulse duration, and 15 mm spot size). After the epidermis peeled off manually by wet gauze, the treatment was followed by sequential application (3 to 4 ) of Q-swithced alexandrite laser (755 nm wavelength, 7 J/cm2 energy fluence, 50 nsec pulse duration, and 3 mm spot size). Combined laser treatment was accomplished after four treatment sessions at 4 months intervals. The efficacy of the treatment was determined by clinical evaluation and melanin reflectance spectroscopy, and histologic examination before laser and 6 months after the last treatment. Results and Conclusion: Clinical response of giant CMN to combined laser treatment was excellent, and a significant improvement was obtained. Melanin reflectance spectroscopy also revealed that melanin content was significantly decreased and that a 94 % clearance was achieved. Histologic examination showed a marked decrese in the number of the nests in the juctional, papillary, and reticular dermis. We conclude that combined laser treatment is an effective therapeutic method in the treatment of small to giant CMN, but further study is warranted to follow-up reccurence or malignant change.
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