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Background Nevus of Ota, caused by dermal melanocytosis, is cosmetically troublesome in Asian patients. The destruction of dermal melanocytosis using Q-switched laser systems carries a high risk of postinflammatory hyperpigmentation/hypopigmentation. Methods To determine the usefulness, safety, and adverse problems of low fluence 1064 nm Q-switched Nd: YAG laser in the treatment of nevus of Ota, 19 Korean patients (five male and 14 female; Fitzpatrick skin type IV) who were clinically diagnosed as having nevus of Ota were enrolled in the present study. Low fluence laser treatments were performed with a collimated Q-switched Nd: YAG laser at intervals of two weeks. The fluence of laser treatments was set at 2.5 J/cm2 and adjusted based on patient response to the previous treatment session and sensitivity to pain. Treatment was applied until the lesions showed mild erythema. Results The mean number of total treatment sessions was 17.1 (range 6-32). Among the 19 patients, 18 reached near total improvement, while one patient failed to reach near total improvement after 11 treatment sessions. The mean fluence of treatment was 2.5 J/cm2 (range 2.0-5.0 J/cm2). Five patients complained of delayed eyelid response. Post-therapy hyperpigmentation was observed in one patient. Conclusion Low fluence 1064 nm Q-switched Nd: YAG laser is an effective modality for the treatment of nevus of Ota with a low incidence of side effects. It is an easy to perform treatment with low downtime. [ABSTRACT FROM AUTHOR]