Nevus Spilus: A Review of Laser-Based Therapeutic Approaches.

BACKGROUND: Nevus spilus (NS) is a congenital melanocytic nevus with specific clinical characteristics. The condition generally appears in the first year of life and shows no gender preference while affecting individuals with lighter skin tones. It has a predilection for lower limbs and trunk areas the NS lesions consist of tiny heavily pigmented papules and macules accumulated on a well-bordered, lighter brown macular backdrop, comparable to a café-au-lait macule, frequently along Blaschko lines. The type of nevus has been reported as a blue nevus, centrofacial lentiginosis, nevus sebaceous, and bilateral nevus of Ito.

OBJECTIVE: To highlight laser options for nevus spilus.

METHODS: A review of various laser-based treatment modalities was conducted, focusing on their application in NS. The lasers included Q-switched ruby (QSRL), alexandrite (QSAL), Nd:YAG 532 and 1064 nm, carbon dioxide (CO2), intense pulsed light (IPL), and pulsed dye laser (PDL).

RESULTS AND DISCUSSION: The laser modalities have shown varying degrees of success in improving the appearance of NS lesions. The QSRL, QSAL and QSNYL lasers are commonly used because they are specific for melanin. Ablative lasers like CO2 and broad-spectrum devices like IPL and PDL have also been employed, each offering different advantages depending on lesion characteristics and treatment goals.

CONCLUSION: Regular monitoring for suspicious malignant degeneration should be done and if any signs of melanoma are present, histological examination is warranted. While no treatment is usually necessary, surgery has been proposed to eliminate the risk of melanoma. Aside from surgical management, various lasers have been tried to treat NS with varied success. QSRL, QSAL, QSNYL 532, and 1064 nm, CO2, IPL and PDL have all been demonstrated to improve NS.