Lasers and Acquired Melanocytic Nevi: A Systematic Review

BACKGROUND: Acquired melanocytic nevi (AMN) are common and cosmetically bothersome. Patients may prefer non-invasive laser modalities, but their efficacy remains uncertain. OBJECTIVE: To assess the utility of lasers for AMN removal. MATERIALS AND METHODS: The authors systematically reviewed MEDLINE, EMBASE, and Scopus from inception to May 9, 2024, using the terms "nevi" and "laser." Our primary outcome was clinical efficacy, measured by physician/investigator-graded clinical assessments of (1) >75% lesion clearance or (2) 95% to 100% clearance (complete response). RESULTS: The authors identified 20 studies, including CO2 (n = 5), Q-switched (QS) and long-pulsed (LP) ruby (n = 4), LP or QS Alexandrite (n = 3), QS Nd:YAG 1064 nm (n = 3), Er:YAG (n = 2), LP Nd:YAG 532 nm (n = 1), diode (n = 1) lasers, and 2 combination studies of Er:YAG with LP Alexandrite (n = 1) or QS Nd:YAG 532 nm (n = 1) laser. Combination Er:YAG treatment achieved >75% clearance in 98.5% to 100% of cases, with better outcomes using LP Alexandrite laser. Eight studies assessed complete response. Combination Er:YAG with QS Nd:YAG 532 nm laser (89.4% of cases) or LP Alexandrite (100%) and LP Alexandrite alone (98.1%) demonstrated the highest clearance. CONCLUSION: Combination of Er:YAG with LP Alexandrite, LP Alexandrite alone, and Er:YAG with QS Nd:YAG 532 nm laser are most effective for nevi clearance.