NYU Langone Health, New York, USA
Title: Laser Therapy of Basal Cell Carcinoma: Evidence Review and Recommendations
Gaurav Singh, MD, MPH, is training in general dermatology, cosmetic dermatology, and surgical dermatology at NYU Langone Health in New York, USA. He has presented to local, state, national, and international audiences on many topics including management of skin malignancies. He is also involved with the hospital’s Patient Safety Council, and takes pride in providing safe, effective, and compassionate care to all his patients.
Basal cell carcinoma (BCC) is the most common cancer in the world and is increasing in incidence. Current standard of treatment includes cryosurgery, electrodessication/curettage, topical immunomodulators, Mohs micrographic surgery, and surgical excision. This review discusses the evidence behind treating BCC with laser devices. 595nm wavelength PDL laser and long-pulsed 1,064nm Nd:YAG laser are promising. In one cohort, 92% of BCCs less than 1.5cm in size demonstrated complete response to PDL, whereas only 25% of BCCs larger than 1.5 cm demonstrated complete response. 90-95% of patients in another study remained tumor free for 21 months after treatment with PDL. Long-pulsed 1064nm Nd:YAG demonstrated complete histologic clearance after one treatment in 92% of non-facial BCCs less than 1.5cm in size in a group of ten patients. Ablative CO2 lasers have also been successfully used. A prospective trial with 140 patients of superpusled CO2 laser demonstrated 100% histologic cure and 0% clinical recurrence at 3 years. In another study, curettage followed by 2-4 passes of super-pulsed CO2 laser achieved 94% cure with 1 session. An analysis of the ablation depth of CO2 laser found that increasing ablation depth from the upper, middle, and lower dermis resulted in clear margins of 40%, 66%, and 93%, respectively. Er:YAG may also be used. One treatment with Er:YAG resulted in histologic clearance in 92% of superficial nodular BCCs at one year in 20 patients. In summary, vascular-selective and ablative devices such as the 595nm PDL, 1064nm Nd:YAG, CO2, and Er:YAG lasers, may be used as alternative or adjunctive therapy to treat BCC. Additional work is needed to determine long-term recurrence rates, outcomes, and device parameters. For now, these lasers should be limited to use in select patients (i.e. poor surgical candidates) and tumor characteristics (i.e. superficial, less than 1.5cm in size, on the trunk/arms/legs).