Lasers do poorly for this type of birthmark. Another method is multiple sessions of fractional CO2 laser- there is a paper by Dr Michael Freeman who has demonstrated improvement with > 12 sessions. Pico lasers may help lighten, but not by much. Agree with Dr Emers R20 method. Surgery will be tricky- any comments regarding tissue expanders and serial excision from our Plastics team?Staged excision maybe possible, but I will leave this for Plastics to comment on. All the best, Dr Davin Lim Laser DermatologistBrisbane, Australia.
There is no way to remove this surgically without significant scarring. Plus this type of birth mark should be followed to ensure no change to skin cancer. With that said, tattoo lasers specifically pico lasers or ultrapulsed q switched lasers with R20 method do best for removal. They likely will not "cure" this but will give improvement. they may need to be combined with fractional or fully ablative co2. Please see a laser fellowship trained physician as this type of congenital mole is very challenging to treat and needs an expert. Best, Dr. Emer.
I would absolutely not do surgery for a birthmark that size unless laser options have been exhausted. Your best bet is to use a q switch laser several times first to see what improvement you can get. If the mark has been growing you should look into a biopsy