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In vitro studies of melanoma cells treated with Q-switched lasers have found changes in cell surface integrin expression, with subsequent alteration of cell migration.47 Another in vitro study found a significant increase in p16INK4a in p16 positive cell lines following irradiation with Q-switched laser light and suggested that sub-lethal laser damage may increase DNA damage leading to an increase in p16 expression.48 In clinical practice, benign appearing nevi that tend to recur following laser treatment may show newfound clinical and histologic atypia, referred to as pseudomelanoma.49 Despite this, there has never been a report of true malignant transformation of a benign pigmented lesion following laser treatment.50 Theoretically, laser treatment of melanocytic lesions may decrease the risk of malignant transformation of a benign pigmented lesion simply by reducing the population of existing potentially premalignant cells

The use of claim 28 wherein the PDE-5 inhibitor is sildenafil, vardenafil, tadalafil or combination thereof