Ultrapulse C0
2 
laser far nevus sebaceus 
Case report 
ULTRAPULSE 
co2 LASER THERAPY 
FOR NEVUS SEBACEUS JADASSOHN 
A. L. Krunic, R. E. Clark and M. M. Uroševič 
ABSTRACT 
Background: Ultrapulse CO
2 
laser could be an effective modality for the ablation of the nevus sebaceus of 
Jadassohn for cosmetically important areas in selected cases. 
Objective: Evaluation of effectiveness and cosmetic results concerning the ultrapulse CO
2 
laser ablation in 15-
year old white boy with nevus sebaceus of the glabellar area. 
Methods: Ablation of the nevus under local anesthesia with ultrapulse CO
2 
laser, in 4 sessions spaced two 
months apart. 
Results: An 18-month follow-up disclosed no recurrent diseases with satisfactory cosmetic result. 
Conclusion: This method produces superior results with minimal risk of scarring compared to a continuous 
wave CO
2 
laser and classical excisional surgery. Although the risk for malignant change of nevus sebaceus on 
the face is very low, careful follow-ups are mandatory in order to obtain early recognition of any possible 
malignant change. 
KEY WORDS 
nevus sebaceus of Jadassohn, ultrapulse CO
2 
laser ablation, cosmetic results 
INTRODUCTION 
Nevus sebaceus of Jadassohn (NSJ) belongs to the 
group of congenital organoid nevi that characteristically 
occurs on the scalp and face 1•2. The overall malignant 
potential is reported to be between 8-12 %, with the 
basal celi carcinoma being the most common 
malignancy developing in these lesions after puberty3• 
The complete surgical excision is considered the 
treatment of choice, especially for the lesions located 
acta demiatovenerologica A.P.A. Vol 6, 97, No 4 
on the scalp which have the highest risk for malignant 
transformation4. The ultrapulse CO
2 
laser with high 
energy and short pulses, achieves controlled penetration, 
minimal nonspecific thermal damage and char-free 
ablation5 and can be a promising tool for • the 
ablation of nevus sebaceus at the cosmetically irnportant 
locations where conventional surgery may produce 
significant mutilation and disfigurement. 
157 
Ultrapulse C0
2 
laser far nevus sebaceus 
Figure l. Nevus sebaceus on the mid forehead prior 
to treatment with Ultrapulse C0
2 
laser. 
CASE REPORT 
We present a 15-year old white boy with the 
35x15 mm linear nevus sebaceus of the glabellar 
area. In the infancy the lesion was flatter and 
pinkish. Recently it became elevated and more 
yellowish in color (Figure 1). The patient had no 
history of seizures, eye abnormalities, or impaired 
intelligence and was in good physical health. 
Histopathologic analysis disclosed slightly acanthotic, 
papillomatous epidermis with increased number of 
sebaceus gland in the upper half of dermis. The 
glands were connected to rudimentary follicular 
infundibula, which were dilated and filled with 
keratin plugs. These findings were consistent with 
the diagnosis of nevus sebaceus. 
The nevus was ablated under local anesthesia (1 % 
lidocaine with epinephrine) with ultrapulse CO 
2 
laser (Coherent, Palo Alto, California), in 4 sessions 
spaced two months apart. The laser settings were 
300 mJ energy/pulse, 50W average power, and 
computerized pattern generator adjusted to the density 
of 7, sizes from 3 to 5 and patterns of 1 and 3. 
Each ablation session consisted of 3 passes to the 
uppermost reticular dermis (Figure 2). 
At twelve months after the surgery satisfactory 
cosmetic result with moderate postinflammatory 
hyperpigmentation was achieved (Figure 3). The 
discoloration resolved with combined use of topical 
hydroquinon 3% solution, tretinoin 0,05% cream 
and sunscreen. At eighteen-month follow-up no 
recurrence of the nevus was seen. 
158 
Figure 2. The treated area immediately after 
vaporization was completed (4th session). 
Figure 3. One year after ablation. Postinflammatory 
hype,pigmentation and mild pinkish discoloration is 
stil! present. 
acta dermatovenerologica A .P.A. Vol 6, 97, No 4 
Ultrapulse CO 
2 
laser for nevus sebaceus 
DISCUSSION 
Nevus sebaceus of Jadassohn (NSJ) is considered 
to be a localized malformation of epidermis, 
pilosebaceus units and ectopic apocrine glands which 
develop in about two thirds of cases1. The natural 
course of NSJ evolves through different stages over 
tirne from a deficient malformation (infantile phase) 
to a hyperplastic sebaceus lesion as a consequence 
of hormones and sexual maturation (adolescent phase)1•6• 
A third stage commonly develops in adulthood 
where different benign adnexal tumors arise in NSJ3. 
The most frequent one is believed to be the 
syringocystadenoma papilliferum, which develops in 
8-19% of cases 1.3_ Malignant transformation of NSJ 
usually occurs in scalp lesions and is considered to 
be much less frequent. Basal cell carcinoma is the 
most common malignancy observed in 5-7% of 
cases3•4• In rare instances, squamous cell carcinoma, 
apocrine carcinoma, and malignant eccrine poroma 
have developed in NSJ that led to regional and even 
generalized metastases4•7• 
Aside from malignant potential, NSJ may present 
cosmetic or functional problems by virtue of its 
different locations on the face2• For all these reasons, 
acceptable treatment is often desirable but not always 
possible. Most investigators consider surgical excision 
as the treatment of choice8• In our patient the tight 
skin on the forehead altogether with the size of the 
lesion, would necessitate repair with the advancement 
flap after the excision. This surgical approach would 
be cosmetically less satisfactory, since it carries the 
risk for disfiguring scar with significant impact on 
the psychology and self-image of the young adolescent. 
Continuous CO
2 
laser in nonfocused mode was 
also used for the ablation of NSJ9 and epidermal 
nevi 10• The ablation of NSJ, although clinically 
successful, resulted in hypertrophic scar on the 
nose9• Ultrapulse CO2 laser technology
5 with controlled 
penetration; char-free ablation and minimal collateral 
terma! damage produced satisfactory result in our 
patient, with transitory postinflammatory hyperpigmen-
tation. The superficial nature of the lesion, the lack 
of the extension to the deep reticular dermis as well 
as the absence of the apocrine component may have 
been additional contributing factors to the success of 
treatment in our patient. 
In conclusion, ultrapulse CO2 laser presents a 
promising modality for the ablation of NSJ in 
selected cases in cosmetically important areas. The 
lesions with the deep apocrine component, as well 
as involvement of the lower half of the dermis 
would qualify better for surgical excision than laser 
ablation because the potentially higher risk of 
recurrence with the later. Nevertheless, even if the 
cosmetic result is acceptable with the laser, and the 
lesion superficial, surgical excision may be a better 
choice if a thin-line scar can be achieved. 
Although the treatment with the CO2 laser was 
claimed to obscure early epidermal changes, with 
careful and prolonged follow-ups any malignant change 
could be recognized and treated quickly before the 
tumor achieves the significant size. Also the risk of 
malignant transformation of NSJ on the face is 
considered to be low3.4. 
REFERENCES 
l. Mehregan AH, Pinkus H Life history of organoid 
nevi. Arch Dermatol 1965; 91: 574-588. 
2. Weng CI, Tsai JC, Chen TJ. Jadassohn 's nevus 
sebaceus of the head and neck. Ann Plast Surg 
1990; 25: 100-102. 
3. Wilson-Jones E, Heyl T. Nevus sebaceus. A report 
of 140 cases with special regard to the development 
of secondary malignant tumors. Br J Dermatol 1970; 
82: 99-117. 
4. Domingo J, Helwig EB. Malignant neoplasms 
associated with nevus sebaceous of Jadassohn. J Am 
Acad Dermatol 1979; 1:545-556. 
acta dennatovenerologica A .P.A. Vol 6, 97, No 4 
5. Kauver ANE, Geronemus RG, Waldorf HA. Char-
free tissue ablation: a comparative histopathological 
analysis of new carbon dioxide (CO) laser systems 
(abstract). Laser Surg Med 1995; 16(Suppl 7): 50. 
6. Alessi E, Sala F. Nevus sebaceus - a clinicopathologi,c 
study of its evolution. Am J Dermatopathol 1986; 8: 
27-31. 
7. Tarkhan II, Domingo l. Metastasizing eccrine 
porocarcinoma developing in sebaceus nevu1 of 
Jadassohn. Arch Dermatol 1985; 121: 413-415. 
8. Baker BB, lmber RJ, Templer JW Nevus sebaceus 
of Jadassohn. Arch Otolaryngol 1975; 101: 515-516. 
159 
Ultrapulse C0
2 
laser far nevus sebaceus 
9. Ashinoff R. Linear nevus sebaceus of Jadassohn 
treated with the carbon dioxide laser. Pediatr Dermatol 
1993; 10: 189-191. 
1 O. Ratz JL, Bailin PL, Wheeland RG. Carbon 
dioxide laser treatment of epidermal nevi. J Dermatol 
Surg Oncol 1986; 12: 567-570. 
AUTHORS' ADDRESSES 
Aleksandar L. Krunic MD, PhD, Director of Dermatologic Surgery, Dermatologic Surgery Unit, 
Department of Dermatology, University of Belgrade School of Medicine, Pasterova 2, 11000 Belgrade, 
Yugoslavia, and Dermatologic Surgery Unit, Division of Dermatology, Duke University Medica! Center, 
Durham, North Carolina 27710, USA 
160 
Robert E. Clark MD, PhD, Dermatologic Surgery Unit, Division of Dermatology, Duke University 
Medica! Center, Durham, North Carolina 27710, USA 
Mirjana M. Uroševic MD, Department of Dermatology, University of Belgrade School of Medicine, 
Pasterova 2, 11000 Belgrade, Yugoslavia. 
acta dennatovenerologica A.P.A. Vol 6, 97, No 4