Background: Although cryotherapy is still the first-line therapy for solar lentigines, due to side effects such as post-inflammatory hyperpigmentation (PIH), especially in patients with darker skin types, pigment specific lasers should be considered as initial treatment. The aim of this study was to evaluate the efficacy and safety of cryotherapy in comparison with 595-nm pulsed dye laser (PDL) with cutaneous compression in the treatment of solar lentigines. Method: Twenty two patients (skin type II- IV) with facial or hand lentigines completed this study. Lesions of one side of the face or each hand were randomly assigned and treated with either cryotherapy or PDL. Treatments were performed with radiant exposures of 10 J/cm2, 7mm spot size and 1.5ms pulse duration with no epidermal cooling. Photographs were taken before treatment and one month later. The response rate and side effects were compared. Results: PDL was more likely to produce substantial lightening of solar lentigines than cryotherapy, especially in skin types III and IV (n=8, n=9; P0.05). PIH was only seen in the cryotherapy group. PDL group only showed minimal erythema. No purpura was observed. Conclusion: PDL with compression is superior to cryotherapy in the treatment of solar lentigines in darker skin types.