[Treatment of giant congenital nevus with high-energy pulsed CO2 laser].

UNLABELLED: All authors agree upon the need for early treatment of giant congenital nevi. The surgeon must seek to minimize the risk of malignancy. The objective calls for radical excision of all pigmented areas; this may be impossible because of the risk of leaving the patient with disfiguring scars. The aim of this study was to assess treatment of giant congenital nevi with the high-energy pulsed CO2 laser as an alternative to surgery.

PATIENTS AND METHODS: Between 1998 and 1999, the high-energy pulsed CO2 laser was used in nine newborns and five children.

RESULTS: The treatment with the high-energy pulsed CO2 laser achieved 70-90% clearing of the giant nevi in most of the children. Two children developed hypertrophic scars on a companion nevi and on giant congenital nevi. One child required a skin graft because of tissue necrosis, associated with a disseminated intravascular coagulation and septic shock.

DISCUSSION: Laser is a surface technique proposed when surgical excision cannot be performed because the surface is too large or the localization is incompatible with surgery. Early treatment, in the first 15 days, is not required for the quality of the cosmetic result. The high-energy pulsed CO2 laser provides satisfactory cosmetic results with short cicatrisation time. It allows the treatment of the companion nevi at the same time. The risk of malignant transformation is greatly but not totally reduced. Regular clinical surveillance should help reduce the risk.