A prospective cohort study evaluated the effectiveness of dermoscopy-guided combined therapy with CO2 and 1064-nm laser for junctional nevus in 153 patients from January 2023 to October 2024. The experimental group (n=77) received CO2 laser with dermoscopy plus 1064-nm laser, the control group (n=76) only CO2 laser with the naked eye. The overall effective rate in the experimental group was 96.10%, significantly higher than 86.84% in the control group (χ²=4.220, P=0.04). The Vancouver Scar Scale score was lower in the experimental group after 1 week (6.47 ± 1.08 vs. 7.82 ± 1.02; t=7.947, P<0.001) and after 1 month (3.02 ± 0.39 vs. 11.18, P<0.001). Patient satisfaction with aesthetics reached 96.10% and efficiency 94.80% in the experimental group, higher than in the control group (esthetics 86.84%, χ²=4.220, P=0.040). Recurrence rates were lower at 2 months (2.60% vs. 10.53%, χ²=3.936, P=0.047) and at 6 months (7.80% vs. 22.37%, χ²=6.3). Combined therapy increases efficacy, reduces scarring, recurrence and improves patient satisfaction.