BACKGROUND There are few reports on therapy for nevus of Ota. Moreover, traditional treatments are largely palliative or risk permanent pigmentary changes and/or scarring. OBJECTIVE The efficacy of the Q-switched ruby laser (694 nm, 40 nsec) as a therapy for nevus of Ota was investigated. METHODS Nine nevi or portions thereof were irradiated up to six times with 4.5 and/or 7.5 J/cm2 at a mean exposure interval of 3 weeks. Sequential skin biopsy specimens were processed for light microscopy, immunohistochemistry, and electron microscopy. RESULTS Cosmetic improvement occurred at both doses in the irradiated parts of the six nevi available for follow-up. No appreciable difference was noted between single and multiple treatments. There was no gross scarring. Light microscopy revealed dose-related immediate injury with more melanophages and fewer dermal melanocytes after irradiation in comparison with control areas. Electron microscopic distinction between dermal melanocytes and melanin-laden macrophages was difficult. A monoclonal antibody to human melanosome-specific antigen type 1 (HMSA-1) was used to distinguish between the two cell populations. CONCLUSIONS Our findings suggest that the Q-switched ruby laser is useful for treating nevus of Ota.