BACKGROUND: Nevus of Ota can be effectively and safely treated since the arrival of q-switched lasers in dermatology. However, available literature is scarce regarding the treatment of Nevus of Ota in skin types darker than IV. OBJECTIVES: We report about four Fitzpatrick phototype V patients treated for Nevus of Ota with a q-switched Nd:YAG laser at 1,064 nm. METHODS: Four patients with Fitzpatrick phototype V were treated for Nevus of Ota with a q-switched Nd:YAG laser at 1,064 nm in a private practice setting. Pulse diameter for the treatments was 2 mm and pulses were applied typically in a non-overlapping fashion. Treatment energies ranged from 4.1 to 9.5 J/cm(2) . RESULTS: All four patients of this case series showed significant cosmetic improvement. Improvement ratings, based upon pre- and post-treatment photographs rated by blinded investigators, were in between 6 and 10 with a mean of 8.5 on a 10-point scale. Side effects were mostly short termed and typical for this laser technique. No post-inflammatory hyperpigmentation was observed however one case of permanent drop-like hypopigmentation was encountered. CONCLUSIONS: A 1,064 nm q-switched Nd:YAG laser treatment could be an effective and reasonably safe treatment for patients with Nevus of Ota and Fitzpatrick skin type V. Patients should be counselled before treatment regarding the risk of permanent hypopigmentation.