Optimization of curative techniques with laser light in congenital giant pigmented nevi in children

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BACKGROUND: Congenital giant pigmented nevi (CGPN) occur in 1:20 000 to 1:500 000 newborns. They are small (1.5 to 5 sq. cm), medium (5 to 50 sq. cm) and a truly gigantic (more than 50 sq. cm) types of pigmented nevi. CGPN create a psychological problem in children, due to aesthetic discomfort. Various techniques for their removal are not always effective and may cause complications: relapse (6–41%), skin scarring (6%), malignancy is possible in adults (10%). The question of CGPN effective removal remains open. This stimulates search for the optimization of applied curative options; and one of the ways is to use laser light for CGPN removal in children. Previously, individual researchers used infrared radiation (λ 10.6 microns) generated by pulsed periodic CO2 laser for this purpose; some experimental work on "blue" (λ 0.45) light generated by diode laser was done too. Experimental studies on the skin of laboratory animals could define features of exposure and promising modes of these types of laser radiation for surgical application in CGPN removal.

AIM: To improve outcomes of treatment of various CGPN forms in children with optimized laser techniques.

METHODS: The CGPN removal was done with "blue" laser light (λ 0.45 micron) using Lasermed 10-03 device manufactured by Russian Engineering Club LLC (Tula) and laser light (λ 10.6 microns) generated by pulsed periodic CO2 laser device ALDAN (manufacturer IOF RAS, Moscow, Russia). 35 children with various CGPN forms were treated in the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma. Among them: 18 patients with a small form, 11 children with an average form, and 6 with a true gigantic form. Children’s age ranged from 6 to 18 years. In 13 children, CGPN located on the face, in 6 — on the anterior surface of the chest, in 8 — on the lower and upper extremities, in 4 — on the abdominal wall and in 4 — on the back.

RESULTS: The final good clinical and aesthetic outcome was registered in 29 children with small and medium CGPN forms. In 6 patients with true gigantic forms, good clinical and satisfactory aesthetic results were registered preliminary, at the treatment stage. No unsatisfactory results were seen.

CONCLUSION: Our experience with optimized techniques using mentioned types of laser light for the removal of various CGPN forms in children has confirmed their clinical and aesthetic effectiveness and outlined the prospect of their application in pediatric surgery.

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作者简介

Stanislav Podurar

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

编辑信件的主要联系方式.
Email: podurar.stanislav@yandex.ru
ORCID iD: 0000-0002-4293-5467
SPIN 代码: 6414-6452

MD

俄罗斯联邦, Moscow

Natalya Gorbatova

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: natashgorbatov@yandex.ru
ORCID iD: 0000-0003-4949-7655
SPIN 代码: 6016-6891

MD, Cand. Sci. (Medicine), Academician of AMTS

俄罗斯联邦, Moscow

Alexander Bryantsev

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: alex_br@doctor-roshal.ru
ORCID iD: 0009-0001-7508-8524
SPIN 代码: 6230-8980

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Moscow

Vladimir Duvansky

The Skobelkin Research and Practical Centre for Laser Medicine

Email: dvaendo@mail.ru
ORCID iD: 0000-0001-5880-2629
SPIN 代码: 1894-8820

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow

Aleksandr Tertychnyy

The First Sechenov Moscow State Medical University

Email: atertychnyy@gmail.com
ORCID iD: 0000-0001-5635-6100
SPIN 代码: 5150-0535

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow

Gennady Varev

Russian Engineering Club

Email: info@lasermed.ru
ORCID iD: 0009-0007-0543-2477

Cand. Sci. (Engineering)

俄罗斯联邦, Tula

Sergey Nikiforov

Prokhorov General Physics Institute of the Russian Academy of Sciences

Email: nikiforov@kapella.gpi.ru
ORCID iD: 0000-0001-7510-4355
SPIN 代码: 9359-0557

Cand. Sci. (Physics and Mathematics)

俄罗斯联邦, Moscow

Yaroslav Simanovsky

Prokhorov General Physics Institute of the Russian Academy of Sciences

Email: symanosky@kapella.gpi.ru
ORCID iD: 0000-0003-0779-1135
SPIN 代码: 3438-9329

Cand. Sci. (Engineering)

俄罗斯联邦, Moscow

参考

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2. Fig. 1. Skin condition of rats immediately after exposure to laser radiation: a — «blue» laser with a power of: 3 W (1); 6 W (2); 10 W (3); b — CO2 laser with energy and frequency: 20 mJ, 10 Hz (1); 30 mJ, 10 Hz (2); 40 mJ, 10 Hz (3); 20 mJ, 20 Hz (4); 30 mJ, 20 Hz (5); 40 mJ, 20 Hz (6).

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3. Fig. 2. Skin condition of mini pigs immediately after exposure to laser radiation: a — «blue» laser with a power of: 3 W (1); 6 W (2); 10 W (3); b — СО2 laser with energy and frequency: 20 mJ, 20 Hz (1); 30 mJ, 20 Hz (2); 40 mJ, 20 Hz (3).

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4. Fig. 3. Skin condition of a laboratory rat immediately after laser exposure: a — λ=0.45 μm, 3 W; b — λ=0.45 μm, 10 W; c — λ=10.6 μm, 20 mJ; d — λ=10.6 μm, 40 mJ.

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5. Fig. 4. Skin condition of a laboratory rat 30 days after laser exposure: a — λ=0.45 μm, 3 W; b — λ=0.45 μm, 10 W; c — λ=10.6 μm, 20 mJ; d — λ=10.6 μm, 40 mJ.

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6. Fig. 5. Histological picture of exposure areas on the skin of rat immediately (0 period) after exposure: a — λ=0.45 μm, 3 W; b — λ=0.45 μm, 10 W; c — λ=10.6 μm, 20 mJ; d — λ=10.6 μm, 40 mJ.

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7. Fig. 6. Histological picture of the skin of a laboratory rat 30 days after laser exposure: a — λ=0.45 μm, 3 W; b — λ=0.45 μm, 10 W; c — λ=10.6 μm, 20 mJ; d — λ=10.6 μm, 40 mJ.

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8. Fig. 7. Skin condition of the mini pig immediately after laser exposure: a — λ=0.45 μm, 3 W; b — λ=0.45 μm, 10 W; c — λ=10.6 μm, 20 mJ; d — λ=10.6 μm, 40 mJ.

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9. Fig. 8. Skin condition of a mini pig 90 days after laser exposure: a — λ=0.45 μm, 3 W; b — λ=0.45 μm, 10 W; c — λ=10.6 μm, 20 mJ; d — λ=10.6 μm, 40 mJ.

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版权所有 © Podurar S.A., Gorbatova N.E., Bryantsev A.V., Duvansky V.A., Tertychnyy A.S., Varev G.A., Nikiforov S.M., Simanovsky Y.O., 2024

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