Copper vapor laser efficacious in periorbital congenital melanocytic nevus

A 14-year-old girl and 23-year-old man presented with a pigmented plaque of size 42 × 35 mm near left lower eyelid and 30 × 50 mm over right periorbital area respectively. The nevi were noted since birth and increased in size during body growth. Based on clinical signs (size [M], location, the number of satellites [S], color uniformity [C], roughness [R], nodules [N] and hair [H]) and dermoscopic data, the diagnosis of congenital melanocytic nevus Type I, M1S0C1R1N0H0 was made which was confirmed by biopsy.

Dual-wavelength radiation of the copper vapor laser treatment was performed using a multiple stacking pass technique. The treatment endpoint was set at achievement of grayish tint of nevus. The area was divided into equal transverse strips of 3–4 mm in width to provide sound healing. First odd strips were irradiated and one month later even strips were irradiated. Both patients received three sessions with a one-month interval.

Post procedure the exposed skin was treated with 0.05% chlorhexidine gluconate. Bepanthen cream was applied twice a day in early post-operative period. The irradiated area remained grayish for several days followed by exfoliation of crusts and regeneration of epidermis without leaving behind any hyperpigmentation. Two weeks post procedure, the irradiated area became entirely similar to adjoining intact skin. Patients were advised to use a broad-spectrum sunscreen during the treatment period and for a month after the last procedure. Both cases did not show any side effects during a 36-month follow-up period.

Ablative lasers like CO2 and Er:YAG on CMN can cause bleeding, scarring and recurrences. Q-switched pigment-specific mid-infrared laser can treat CMN with a lower complication rate, but there is a risk of persistent erythema, edema, relapse and risk of eye injury.

The copper vapor laser seems to be an optimal approach to the treatment of periorbital CMN due to the high absorption of the 511 nm radiation by melanin. Melanin absorbs the radiation with a wavelength of 511 nm, 10 times more than the radiation with 1064 nm wavelength. Hence, selective photodestruction of melanosome with copper vapor laser requires less light energy than the mid-infrared laser. The high absorption of 578 nm radiation by oxyhemoglobin and hemoglobin as well as high absorption of 511 nm radiation by melanin limits the penetration depth of the laser and protects the underlying eye structures from injuries. Remodeling of the vascular bed through selective vessel coagulation under the radiation with a wavelength of 578 nm prevents post-irradiation bleeding and relapse of congenital melanocytic nevus.

In conclusion dual-wavelength copper vapor laser appears to be an effective, safe option in removal of periorbital congenital melanocytic nevus with low recurrence and complication rates.

Source- Ponomarev IV, Topchiy SB, Andrusenko YN, Shakina LD. Treatment of congenital melanocytic nevi in the periorbital area with dual-wavelength copper vapor laser. Indian J Dermatol Venereol Leprol 2021;87:720-2.