Review Highlights Laser Treatment of Nonmelanoma Skin Cancer

TOPLINE:

Published data on laser treatment of nonmelanoma skin cancer is encouraging, although the therapy is not yet approved by the Food and Drug Administration (FDA) for this use.

METHODOLOGY:

• Using MEDLINE, the Cochrane Library, and www.clinicaltrials.gov, researchers systematically reviewed 50 unique published articles that evaluated the role of laser therapy for nonmelanoma skin cancer (NMSC).
• Of the 50 studies, 37 focused on lasers for the treatment of basal cell carcinoma (BCC), 10 on lasers for the treatment of squamous cell carcinoma (SCC), and three on the treatment of both tumor types.
• The analysis was limited to studies published in English from the first data available through May 1, 2023.

TAKEAWAY:

• Data was strongest for the use of lasers for treating BCC, especially pulsed dye lasers (PDL). Of 11 unique studies on PDL as monotherapy for managing BCCs, clearance rates ranged from 14.3% to 90.0%.
• For SCCs, 13 studies were identified that evaluated the use of lasers alone or in combination with PDL for treating SCC in situ. Among case reports that used PDL and thulium lasers separately, clearance rates of 100% were reported, while several case series that used the CO₂ laser reported response rates that ranged from 61.5% to 100%.
• The best evidence for clearing both BCC and SCC tumors was observed when ablative lasers such as the CO₂ or erbium yttrium aluminum garnet are combined with methyl aminolevulinate–photodynamic therapy (PDT) or 5-aminolevulinic acid–PDT, “likely due to increased delivery of the photosensitizing compound to neoplastic cells,” the authors wrote.

IN PRACTICE:

“Additional investigations with longer follow-up periods are needed to determine optimal laser parameters, number of treatment sessions required, and recurrence rates (using complete histologic analysis through step sectioning) before lasers can fully be adopted into clinical practice,” the authors wrote. “Surgical excision, specifically Mohs micrographic surgery,” they added, “persists as the gold standard for high-risk and cosmetically sensitive tumors, offering the highest cure rates in a single office visit.”

SOURCE:

Amanda Rosenthal, MD, of the Department of Dermatology at Kaiser Medical Center, Los Angeles, and colleagues conducted the review. The study was published in the August issue of Dermatologic Surgery.

LIMITATIONS:

L aser therapy is not FDA-approved for the treatment of NMSC and remains an alternative treatment option. Also, most published studies focus on BCCs, while studies on cutaneous SCCs are more limited.

DISCLOSURES:

The researchers reported having no financial disclosures.