Congenital Melanocytic Nevi: Catch Them Early!
A 2-week-old male neonate of full-term normal vaginal delivery presented with CMN []. The nevus was present over the face involving lower forehead, the eyelids, nose, and both cheeks. On examination, the neonate was clinically normal. Under general anesthesia, we performed electrocautery and surgical curettage over the entire lesion except the eyelids in order to prevent trivial injuries to the eye. The wound was dressed with non-adherent antibiotic tulle (Sofra-tulle) and thisdressingwas removed after 48 h. The raw area showed crusting with ulceration which gradually healed with almost 60-70% clearance of the nevus [].\nSix months later, the infant presented with residual lesion over the cheeks and nose and fine hairs over the cheek areas. The treatment was planned to performboth Q-switched Nd: YAG and CO2 lasers. Once again under general anesthesia with the help of an ophthalmologist to safeguard the eyeballs, a metallic flat shield was placed by lifting the upper eyelid since ophthalmic guard was not available []. The face of the infant was thoroughly wrapped with wet drapes during the procedure. The affected area was treated with Q-switched Nd: YAG laser (Medlite C6, Conbio Aesthetic Lasers, Freemont, USA) using the following settings: 1064 wavelength, 2J/cm2 fluence, 6 mm spot size, and repetition rate of 5. The settings of CO2 laser (Acupulse, Lumenis Ltd, Yokneam, Israel) under super pulse mode were fluence of 15J, spot size of 2 mm, and depth of 1 mm. During this treatment, the lesions over the eyelids weretreated with both lasers in addition to the residual lesions over cheek and nose. CO2 laser ablation was used by defocusing the beam to cause superficial damage. The post-operative period was uneventful with normal vision. Following this procedure, the lesion cleared upto 85-90% with minimal to no scarring [].