Fractional Laser for Prevention of Non-melanoma Skin Cancer

September 2023 | Volume 22 | Issue 9 | 953 | Copyright © September 2023


Published online August 29, 2023

Erika T. McCormick BScc, Sapana Desai MD, Kamaria Nelson MD, Adam Friedman MD FAAD

George Washington University Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC

AFLs have also been studied as a pre-treatment to photodynamic therapy (PDT) due to their ability to improve uptake of topical drugs. AFL treatment preceding PDT was significantly more effective than conventional PDT; 92% of patients had a complete response, compared to 66% for conventional PDT, and recurrence rates were significantly lower.21 Additionally, AFL-assisted PDT may allow for reduced incubation time with the photosensitizing agent without compromising efficacy.21,22

Non-ablative Fractional Lasers
In contrast to AFLs, non-ablative FLs (NAFLs) have a milder treatment effect, causing controlled dermal tissue injury without compromising the epidermis.3 The data is less clear regarding efficacy of NAFL as monotherapy for AKs. In a study by Katz et al, NAFL clinically decreased AKs by 56%, however, 83% of follow-up biopsies had persistent dysplastic cells between MTZ and were diagnosed as AK or squamous cell carcinoma (SCC).6 Conversely, Weiss et al. doubled the density of MTZ in their treatment protocol and found that NAFL monotherapy was efficacious, reducing AKs by 87% with 86% of follow-up biopsies demonstrating AK clearance.7 

Delaying Development of NMSC
Preliminary research is also encouraging for use of FLs in patients with NMSC history to prevent additional NMSCs, however, data is overall limited. One in vivo study found that repeated AFL treatment in UV-exposed hairless mice delayed SCC development compared to control mice by 12, 19, and 30 days for the 1st, 2nd, and 3rd tumors.5 Additionally, a retrospective review of patients with prior facial NMSC revealed that NAFL treatment decreased risk of subsequent NMSC development by nearly 50% (20.9% vs 40.4%) and significantly delayed timing of development compared to controls.23

Conclusion
FL treatment is a promising strategy for NMSC prevention; FLs injure photodamaged skin and promote a regenerative wound healing response, in addition to modulating cutaneous biologic processes contributing photocarcinogenesis, such as IGF-1 signaling. However, further research is needed to establish consensus on FL treatment protocols, as current studies utilize a variety of laser types, settings, and treatment schedules. Additional work will also be required to fully understand the role of FL relative to currently available NMSC prevention therapies. 

Disclosure
The authors declare no conflicts of interest.
 

REFERENCES

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AUTHOR CORRESPONDENCE

Adam Friedman MD FAAD ajfriedman@mfa.gwu.edu
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