Sardana Kabir, Chakravarty Payal, Goel Khushbu
Department of Dermatology and STD, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Delhi, India.
Clin Cosmet Investig Dermatol. 2014 Mar 19;7:89-103. doi: 10.2147/CCID.S57782. eCollection 2014.
Although common acquired melanocytic nevi are largely benign, they are probably one of the most common indications for cosmetic surgery encountered by dermatologists. With recent advances, noninvasive tools can largely determine the potential for malignancy, although they cannot supplant histology. Although surgical shave excision with its myriad modifications has been in vogue for decades, the lack of an adequate histological sample, the largely blind nature of the procedure, and the possibility of recurrence are persisting issues. Pigment-specific lasers were initially used in the Q-switched mode, which was based on the thermal relaxation time of the melanocyte (size 7 μm; 1 μsec), which is not the primary target in melanocytic nevus. The cluster of nevus cells (100 μm) probably lends itself to treatment with a millisecond laser rather than a nanosecond laser. Thus, normal mode pigment-specific lasers and pulsed ablative lasers (CO2/erbium [Er]:yttrium aluminum garnet [YAG]) are more suited to treat acquired melanocytic nevi. The complexities of treating this disorder can be overcome by following a structured approach by using lasers that achieve the appropriate depth to treat the three subtypes of nevi: junctional, compound, and dermal. Thus, junctional nevi respond to Q-switched/normal mode pigment lasers, where for the compound and dermal nevi, pulsed ablative laser (CO2/Er:YAG) may be needed. If surgical excision is employed, a wide margin and proper depth must be ensured, which is skill dependent. A lifelong follow-up for recurrence and melanoma is warranted in predisposed individuals, although melanoma is decidedly uncommon in most acquired melanocytic nevi, even though histological markers may be seen on evaluation.
虽然常见的获得性黑素细胞痣大多是良性的，但它们可能是皮肤科医生遇到的最常见的美容手术适应症之一。随着最近的进展，非侵入性工具在很大程度上可以确定恶性潜能，尽管它们不能取代组织学检查。尽管经过无数改进的手术削除术已经流行了几十年，但缺乏足够的组织学样本、该手术很大程度上的盲目性以及复发的可能性仍然是存在的问题。色素特异性激光最初以调Q模式使用，这是基于黑素细胞的热弛豫时间（大小7μm；1微秒），而黑素细胞不是黑素细胞痣的主要靶点。痣细胞团（100μm）可能更适合用毫秒激光而不是纳秒激光治疗。因此，正常模式的色素特异性激光和脉冲消融激光（二氧化碳/铒[Er]：钇铝石榴石[YAG]）更适合治疗获得性黑素细胞痣。通过采用结构化方法，使用能达到适当深度以治疗痣的三种亚型（交界痣、混合痣和皮内痣）的激光，可以克服治疗这种疾病的复杂性。因此，交界痣对调Q/正常模式色素激光有反应，而对于混合痣和皮内痣，可能需要脉冲消融激光（二氧化碳/铒：钇铝石榴石）。如果采用手术切除，必须确保足够宽的切缘和适当的深度，这取决于手术技巧。对于易感个体，有必要进行终身随访以观察复发和黑色素瘤情况，尽管在大多数获得性黑素细胞痣中黑色素瘤确实不常见，即使在评估时可能会看到组织学标志物。
