A case of labial lentigines in Peutz-Jeghers syndrome treated using a Q-switched alexandrite laser

Shuai Yang,Hong Xu,Ying Zhang,Changbo Tao,Peisheng Jin

Department of Plastic Surgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,Jiangsu,China

Keywords:Labial lentigines Peutz-jeghers syndrome Q-switched alexandrite laser Treatment

ABSTRACT Peutz-Jeghers syndrome (PJS) is a polygenic autosomal dominant disease characterized by multiple gastrointestinal polyps and pigmentation of the mucosa and skin.While there are a few reports regarding successful treatment of intestinal polyps in PJS,there is little research regarding treatment of mucocutaneous melanosis.This study investigated the many advantages of using a Q-switched alexandrite laser to treat mucocutaneous melanosis.In this case,a 19-year-old male with PJS presented with labial lentigines and received two Q-switched alexandrite laser treatments in 2018.Subsequently,the efficacy of the treatment was evaluated.The result of the evaluation was that,after the two laser treatments,the labial lentigines were successfully removed,and there were no complications.

1.Introduction

Peutz-Jeghers syndrome (PJS) is a polygenic autosomal dominant disease characterized by multiple gastrointestinal polyps,in addition to pigmentation of the mucosa and skin.1-5In patients with PJS,irregularly pigmented macules of varying sizes and colors can be found on the vermillion border of the lip,palate,perioral skin,buccal mucosa,and tongue.Common treatments,such as cryosurgery,surgical excision,electrodesiccation,dermabrasion,and carbon dioxide or argon laser ablation,commonly result in incomplete removal of the macules,scarring,or changes in normal pigmentation.Although there are a few reports regarding successful treatment of intestinal polyps in patients with PJS,6,7there is little research regarding treatment of the associated mucocutaneous melanosis.8-10This study reports a case of labial lentigines in a patient with PJS that was treated using a Q-switched alexandrite laser.

2.Case presentation

A 19-year-old male with PJS presented to the plastic surgery outpatient clinic at the Affiliated Hospital of Xuzhou Medical University with labial lentigines.The disease had been detected in the patient around the age of 5 years.Several black-pigmented macules begin to appear on the lips,and the size of the pigmented macules gradually increased,until eventually they extended over the entire lip(Fig.1).The patient had not received prior treatment for labial lentigines.Digital photographs were taken before each treatment and at each subsequent visit to evaluate treatment efficacy.

The subject provided informed consent prior to treatment.The treatment area was identified as the labial lentigines.The face was cleaned,disinfected with 75% alcohol,and dried.A Q-switched alexandrite laser with a 755-nm wavelength and a 50-ns pulse duration setting was used.All treatments were performed using a 2-mm spot size and fluence between 4 and 9 J/cm.2No topical anesthesia was needed before the operation,although topical antibiotic ointment was applied to the treated site to prevent possible infection after the operation.The patient was advised to be vigilant about sun protection,and a follow-up was performed to evaluate the treatment efficacy and complications.

The labial lentigines immediately disappeared or faded after the first laser irradiation.Their surfaces became whitish,and grayish patches were seen at the treated site,accompanied by edema.Crust formed within 1-2 days and sloughed off after one week.The treatment interval was 3 months,and the first treatment effect was evaluated prior to the second treatment(Fig.2).The second treatment used the same protocol as the first,and long-term follow-up was conducted after the final treatment.Fig.3 shows a photograph taken 1 year after the final treatment.The labial lentigines were removed successfully without recurrence,scar formation,or other complications.

Fig.1.Before treatment,black-pigmented macules extended over the entire lip.

Fig.2.On follow-up after the first treatment,the patient’s labial lentigines were reduced in size and lightened in color.

Fig.3.At a follow-up assessment one year after the last treatment,the labial lentigines were removed successfully without recurrence,scar formation,or other complications.The patient satisfaction was excellent.

3.Discussion

Pigmentation of mucosa and skin,along with multiple gastrointestinal polyps,is characteristic of PJS.Mucocutaneous melanosis in PJS seriously affects the physical and mental health of patients,1-5but its treatment still perplexes the majority of clinicians.Previous treatments,such as surgical excision,electrodesiccation,cryosurgery,dermabrasion,and carbon dioxide or argon laser ablation,commonly result in incomplete removal of the polyps,scarring,or changes in normal pigmentation.6,7,11,12In this case,we treated labial lentignes with a Q-switched alexandrite laser and achieved a satisfactory therapeutic outcome.Long-term follow-up suggests that the labial lentigines were removed successfully without recurrence,scar formation,or other complications.In clinical practice,there are also reports of successful cases of applying Q-switched Nd-YAG laser treatment and Q-switched ruby laser treatment,which provide additional options for the treatment of mucocutaneous melanosis in PJS.

4.Conclusion

Our study supports the use of a Q-switched alexandrite laser for safe and effective treatment of labial lentigines in PJS.

Ethics Declarations

Ethics approval and consent to participate

The need for ethical approval was waived as this is a case report.

Consent for publication

The patient gave written informed consent to publish the data contained within this study.

Competing interest

The authors declare that they have no competing interests.

Authors’ contributions

Yang S:Data curation,Writing-Original draft.Tao C:Investigation.Xu H:Resources.Zhang Y:Investigation.Jin P:Supervision.