Department of Dermatology, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Netherlands Institute for Pigment Disorders, Department of Dermatology, University of Amsterdam, the Netherlands.
Br J Dermatol. 2018 Feb;178(2):369-383. doi: 10.1111/bjd.16094. Epub 2018 Jan 19.
Recent studies on congenital melanocytic naevi (CMN) indicate a lower risk of melanoma than has been previously assumed. As a result, the treatment paradigm in CMN has shifted from complete removal to cosmetically acceptable, less invasive treatment options, such as laser treatment. Our objective was to review systematically the efficacy and safety of laser therapy for CMN. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and PubMed. We rated the quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-four eligible studies (three nonrandomized controlled studies; 21 case series) with 434 patients were included; the majority were of poor quality). Twenty different laser modalities or combinations were evaluated. Overall, the Q-switched laser was used most frequently, although large or giant CMN were generally treated with an ablative laser. Owing to heterogeneity between studies, comparison between laser modalities was hampered and statistical analysis was precluded. Lasers in CMN showed rather good results (albeit with very low-quality evidence) for clearing of hyperpigmentation in the short term. Outcome measures varied widely, patient satisfaction was rarely measured and high incidences of scarring, repigmentation and complications were reported. No malignant change was seen. While most studies report short-term improvement of CMN after laser therapy, there is no high-quality evidence for the efficacy and safety of laser modalities in CMN in the long term. Future research should focus on well-conducted and well-reported prospective studies on different laser modalities for CMN, with the use of recognized and validated outcome measures.
最近对先天性黑色素痣（CMN）的研究表明，其患黑色素瘤的风险低于先前的假设。因此，CMN 的治疗模式已经从完全切除转变为更具美容效果、侵入性更小的治疗选择，例如激光治疗。我们的目标是系统地回顾激光治疗 CMN 的疗效和安全性。我们检索了 MEDLINE、Embase、Cochrane 对照试验中心注册库和 PubMed。我们使用推荐评估、制定与评价（GRADE）方法来评估证据质量。共纳入 24 项符合条件的研究（3 项非随机对照研究；21 项病例系列研究），涉及 434 例患者；其中大多数研究质量较差。评估了 20 种不同的激光模式或组合。总体而言，Q 开关激光应用最为广泛，尽管大或巨大的 CMN 通常采用消融性激光治疗。由于研究之间存在异质性，因此阻碍了激光模式之间的比较，并且无法进行统计分析。CMN 中的激光在短期内清除过度色素沉着方面显示出相当好的效果（尽管证据质量非常低）。结果测量指标差异很大，很少测量患者满意度，并且报告了较高的疤痕、复色和并发症发生率。未观察到恶性变化。虽然大多数研究报告 CMN 激光治疗后短期改善，但缺乏长期激光模式治疗 CMN 的疗效和安全性的高质量证据。未来的研究应侧重于不同激光模式治疗 CMN 的精心设计和报告良好的前瞻性研究，使用公认和经过验证的结果测量指标。
