背景:关于巨大先天性黑素细胞痣(GCMN)的激光治疗研究有限。
目的:我们试图阐明铒:YAG激光对GCMN的疗效以及与阳性临床反应相关的组织学因素。
方法:在2019年至2022年之间,我们招募了30名接受Er:YAG激光治疗的中至巨型CMN患者。所有患者在激光治疗前后均接受活检。临床疗效结果通过研究者的全球评估(IGA)进行评估,脱色5点量表,治疗后至少6个月,温哥华疤痕量表(VSS)评分。
结果:在30例中,18(60.0%)显示改善(IGA评分≥3)。8例(26.7%)患者出现色素沉着。八名(26.7%)患者出现了肥厚性疤痕。平均IGA,脱色,VSS评分分别为2.93、3.57和3.20。IGA评分较高(3.24±1.18vs.2.22±0.97,p=0.031)和较低的再色素沉着率(14.3%vs.55.6%,在具有Grenz区的情况下观察到p=0.032)。IGA评分较高(3.33±1.24vs.2.13±0.89,p=0.023),色素沉着率较低(11.1%vs.50.0%,p=0.034)在黑素细胞与黑色素聚集的情况下也是如此。与深层消融相比,浅层消融导致的增生性瘢痕形成较少(5.9%vs.53.8%,p<0.05)。
结论:Er:YAG激光对GCMNs具有有效的临床效果。grenz区和黑色素聚集的黑素细胞巢是激光功效的有希望的预测因子。
Limited research exists on laser treatment of giant congenital melanocytic nevus (GCMN).
We sought to elucidate the efficacy of the Erbium: YAG laser on GCMN and the histologic factors associated with a positive clinical response.
Between 2019 and 2022, we enrolled 30 medium-to-giant CMN patients who underwent Er: YAG laser treatment. All patients received biopsies before and after laser treatments. Clinical efficacy outcomes were evaluated by the investigator\'s global assessment (IGA), 5-point scale of depigmentation, and Vancouver Scar Scale (VSS) scores at least 6 months after treatment.
Of the 30 cases, 18 (60.0%) showed improvement (IGA score ≥3). Eight (26.7%) patients showed repigmentation. Eight (26.7%) patients developed hypertrophic scars. The average IGA, depigmentation, and VSS scores were 2.93, 3.57, and 3.20. The IGA score was higher (3.24 ± 1.18 vs. 2.22 ± 0.97, p = 0.031) and a lower repigmentation rate (14.3% vs. 55.6%, p = 0.032) was observed in the cases with Grenz zone. The IGA score was higher (3.33 ± 1.24 vs. 2.13 ± 0.89, p = 0.023) and the repigmentation rate was lower (11.1% vs. 50.0%, p = 0.034) also in the cases with the melanocytes nests with aggregation of melanin. Lesions with superficial ablation resulted in less hypertrophic scar formation than those with deep ablation (5.9% vs. 53.8%, p < 0.05).
The Er: YAG laser demonstrated effective clinical results for GCMNs. The grenz zone and the melanocytes nests with aggregation of melanin are promising predictors of laser efficacy.