Laser Treatment of Pigmented Lesions

Overview / Definition Laser treatment for pigmented lesions involves the use of focused light energy to target and disrupt melanin-containing cells in the skin. This technique is employed to treat a variety of conditions, such as nevi (moles), lentigines (sun spots), and melasma (hyperpigmentation), with the aim of improving cosmetic appearance and skin health. Epidemiology Pigmented lesions are prevalent in the general population, with varying incidence rates depending on the specific type of lesion. Some key epidemiological facts include: Nevi are common, with up to 50% of the adult population having at least one. Lentigines are more frequent in individuals with higher sun exposure, particularly in older adults. Melasma predominantly affects women, particularly those with darker skin types, often during pregnancy. Pathophysiology / Mechanism The pathophysiology of pigmented lesions varies by type, but generally involves the accumulation of melanin within the epidermis and/or dermis. Laser treatment utilizes the principle of selective photothermolysis, where: Specific wavelengths of laser light are absorbed by melanin. This absorption causes thermal destruction of pigment-containing cells while sparing surrounding tissues. Different lasers target various depths and types of pigmentation. Clinical Presentation Pigmented lesions can present in various forms, including: Nevi: Well-circumscribed, brown or black lesions, typically round or oval. Lentigines: Flat, brown spots often associated with sun exposure. Melasma: Symmetrical, brownish patches on the face, particularly the cheeks and forehead. Diagnosis / Workup The diagnosis of pigmented lesions often relies on clinical evaluation, but may also include: Dermatoscopic examination to assess lesion morphology. Biopsy for histopathological confirmation, especially for atypical lesions. Assessment of patient history regarding sun exposure and family history of skin cancer. Treatment / Management Laser treatment options