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Rosenthal A, Juhasz MLW, Chang C, Gharavi NM. Lasers for the Treatment of Nonmelanoma Skin Cancer: A Systematic Review of the Literature. Dermatol Surg 2024:00042728-990000000-00766. [PMID: 38651741 DOI: 10.1097/dss.0000000000004198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Lasers may present an alternative treatment modality for the management of nonmelanoma skin cancer (NMSC). OBJECTIVE To investigate lasers as a definitive treatment of NMSC. METHODS A comprehensive search was performed on MEDLINE, the Cochrane Library, and the National Institutes of Health (www.clinicaltrials.gov). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to finalize a list of relevant literature studies evaluating the role of laser therapy for NMSC. Articles published through May 1, 2023, were included. RESULTS The authors identified 37 studies investigating nonablative and ablative lasers alone and in combination with other lasers, noninvasive imaging, and additional modalities for the treatment of basal cell carcinomas, 10 focusing on squamous cell carcinoma in situ and 3 focusing on the treatment of both basal and squamous cell carcinomas. CONCLUSION Although surgical management continues to be superior to laser therapy for the management of high-risk and cosmetically sensitive tumors, laser therapy may be an acceptable alternative for low-risk lesions on the trunk and extremities. However, further studies are needed to optimize parameters, determine maximal efficacy, and provide long-term follow-up before the adoption of laser therapy for NMSC into daily clinical practice.
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Affiliation(s)
- Amanda Rosenthal
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Margit L W Juhasz
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
- Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Crystal Chang
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Nima M Gharavi
- Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California
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Christensen RL, Wiinberg M, Lerche CM, Demehri S, Olesen UH, Haedersdal M. Anti-PD-1 immunotherapy with adjuvant ablative fractional laser displays increased tumour clearance of squamous cell carcinoma, a murine study. Exp Dermatol 2024; 33:e15013. [PMID: 38414090 DOI: 10.1111/exd.15013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/06/2023] [Accepted: 12/28/2023] [Indexed: 02/29/2024]
Abstract
PD-1 checkpoint inhibitors are used as systemic immunotherapy for locally advanced and metastatic cutaneous squamous cell carcinoma (SCC); however, improved treatment efficacy is urgently needed. In this study, we aimed to investigate the effect of combining systemic anti-PD-1 treatment with adjuvant ablative fractional laser (AFL) in a spontaneous SCC mouse model. Tumours induced by ultraviolet radiation in the strain C3.Cg-Hrhr /TifBomTac were divided into four groups: anti-PD-1-antibody+AFL (n = 33), AFL alone (n = 22) anti-PD-1-antibody alone (n = 31) and untreated controls (n = 46). AFL was given at Day 0 (100 mJ/mb, 5% density), while anti-PD-1-antibody (ip, 200 μg) at Days 0, 2, 4, 6 and 8. Response to treatment was evaluated by tumour growth, survival time and by dividing response to treatment into complete responders (clinically cleared tumours), partial responders (reduced tumour growth rate compared to untreated controls) and non-responders (no decrease in tumour growth rate compared to untreated controls). The strongest tumour response was observed following the combination of systemic anti-PD-1 treatment combined with laser exposure, resulting in the highest percentage of complete responders (24%) compared with untreated controls (0%, p < 0.01), AFL monotherapy (13%, p > 0.05) and anti-PD-1-antibody monotherapy (3%, p > 0.05). Moreover, all three treatment interventions demonstrated significantly reduced tumour growth rates compared with untreated controls (p < 0.01), and the mice had significantly longer survival times (p < 0.01). In conclusion, the combination treatment revealed an improved treatment effect that significantly enhanced the complete tumour clearance not observed with the monotherapies, indicating a possible additive effect of anti-PD-1 with adjuvant AFL in treatment of SCC.
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Affiliation(s)
- Rikke Louise Christensen
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Martin Wiinberg
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Catharina Margrethe Lerche
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Shadmehr Demehri
- Center for Cancer Immunology and Cutaneous Biology Research Center, Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Uffe Høgh Olesen
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
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El-Khalawany M, Saudi WM, Ahmed E, Mosbeh A, Sameh A, Rageh MA. The combined effect of CO 2 laser, topical diclofenac 3%, and imiquimod 5% in treating high-risk basal cell carcinoma. J Cosmet Dermatol 2021; 21:2049-2055. [PMID: 34333841 DOI: 10.1111/jocd.14354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/08/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Some basal cell carcinoma (BCC) patients are considered as a high risk regarding the site, size, histopathological variant, or recurrence. High-risk BCC is a challenging therapeutic problem due to the trial to balance between complete surgical excision from one side and tissue preservation from the other side. AIM To evaluate the efficacy of combining ablative CO2 laser, imiquimod 5%, and diclofenac 3% as a therapeutic regimen in high-risk and inoperable BCC. PATIENTS/METHODS The study was conducted on 14 patients that were assessed clinically and pathologically then categorized regarding the site, size, histopathology, and fitness for surgery as high-risk inoperable BCC. They received an ablative session of CO2 laser, followed by application of diclofenac sodium 3% gel once daily for 5 days and imiquimod 5% cream for another 2 days. RESULTS The study included 11 males and 3 females. Nine lesions were located on the scalp, 4 on the face, and one lesion on the trunk. All lesions were of large size >5 cm in diameter. Histopathology showed 4 patterns: nodular type in 8 patients, infiltrating type in 3 patients, metatypical type in 2 patients, and micronodular type in one patient. At the end of the treatment period, 9 patients showed significant (moderate to marked) improvement while 5 patients showed weak (poor to mild) response. Significant improvement was more observed in nodular type. Relapse was more observed during the 5th to 6th months with 2 patients showed no relapse. CONCLUSION This combined regimen is a good alternative therapeutic modality in high-risk inoperable BCC especially the nodular pathologic pattern.
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Affiliation(s)
- Mohamed El-Khalawany
- Department of Dermatology and Venereology, Al-Azhar University, Cairo, Egypt.,Department of Dermatology and Venereology, Egyptian Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Wael M Saudi
- Department of Dermatology and Venereology, Misr University for Science and Technology, Cairo, Egypt
| | - Eman Ahmed
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Helwan University, Cairo, Egypt
| | - Alsadat Mosbeh
- Department of Dermatology and Venereology, Al-Azhar University, Cairo, Egypt
| | - Ahmed Sameh
- Department of Dermatology and Venereology, Egyptian Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Mahmoud A Rageh
- Department of Dermatology and Venereology, Al-Azhar University, Cairo, Egypt
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Sharon E, Snast I, Lapidoth M, Kaftory R, Mimouni D, Hodak E, Levi A. Laser Treatment for Non-Melanoma Skin Cancer: A Systematic Review and Meta-Analysis. Am J Clin Dermatol 2021; 22:25-38. [PMID: 32930983 DOI: 10.1007/s40257-020-00562-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Surgery is the mainstay of treatment for non-melanoma skin cancer. Lasers are an additional option. OBJECTIVE The objective of this study was to review the literature on the efficacy and safety of lasers for the treatment of non-melanoma skin cancer. METHODS A systematic review and meta-analysis of laser treatment for non-melanoma skin cancer was performed. The primary outcome was recurrence rate (RR). RESULTS The review included 32 studies (six randomized controlled trials and 26 cohort studies): 27 evaluated basal cell carcinomas (BCCs), three squamous cell carcinomas, and two both, for a total of 4755 BCCs and 214 squamous cell carcinoas. Most BCCs were low risk. The Nd:YAG laser (seven studies, 3286 BCCs) had a 3.1% RR (95% confidence interval [CI] 1.4-6.4%) during a mean follow-up of 7.9 years, with a low rate (< 20%) of scarring and dyspigmentation. The CO2 laser (ten studies, 904 BCCs) had a 9.4% RR (95% CI 4.1-20) during a mean follow-up of 2.1 years, with a low rate of side effects. The pulsed dye laser (eight studies, 206 BCCs) had a 38% RR (95% CI 24-55). In two studies, the Nd:YAG laser demonstrated a RR of 10% (95% CI 2-31) for Bowen's disease, and in three studies, the CO2 laser demonstrated a RR of 22% (95% CI 5-61) for squamous cell carcinoma. CONCLUSIONS Based on cohort studies, the Nd:YAG laser is a safe and efficacious modality for the treatment of low-risk BCC. Based on settings applied in prior studies in the literature, the CO2 laser is less efficacious than the Nd:YAG laser, thus it cannot be recommended for BCC treatment. Insufficient data preclude conclusions regarding laser treatment for squamous cell carcinoma. REGISTRATION PROSPERO registration number CRD42019129717.
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O'Donoghue N, Mowatt D, Sykes AJ. Electrochemotherapy and Ablative Therapies in Non-melanoma Skin Cancer. Clin Oncol (R Coll Radiol) 2019; 31:e1-e9. [PMID: 31543301 DOI: 10.1016/j.clon.2019.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/02/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
Abstract
Although surgery and radiotherapy remain the most commonly used treatments for non-melanoma skin cancer, there are a variety of alternatives. Here we discuss the use of electrochemotherapy and ablative treatments and examine the evidence for their effectiveness against a number of non-melanoma skin cancers.
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Affiliation(s)
- N O'Donoghue
- Salford Royal NHS Foundation Trust Hospital, Salford, UK
| | - D Mowatt
- The Christie NHS Foundation Trust Hospital, Manchester, UK
| | - A J Sykes
- The Christie NHS Foundation Trust Hospital, Manchester, UK.
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Abstract
BACKGROUND Skin cancer remains the most prevalent type of cancer in the United States, and its burden on the health care system remains substantial. Standard treatments such as cryosurgery, electrodessication and curettage, topical and photodynamic therapies, and surgical excision including Mohs micrographic surgery are not without inherent morbidity, including risk of bleeding, infection, and scar. OBJECTIVE Lasers may be an alternative for treatment of nonmelanoma skin cancer, and this paper reviews this therapeutic option. METHODS A comprehensive search in the Cochrane Library, MEDLINE, and PUBMED databases was performed to identify relevant literature investigating the role of laser therapy in the treatment of nonmelanoma skin cancer. RESULTS New literature regarding laser treatment of nonmelanoma skin cancer is emerging, demonstrating promising clinical outcomes. The greatest efficacy has been seen with vascular-selective and ablative lasers in the treatment of basal cell carcinomas. Some success has been reported for laser treatment of squamous cell carcinoma, but data are less convincing. In summary, laser therapy offers an alternative treatment option for nonmelanoma skin cancer; however, its clinical efficacy is variable and, at this time, remains less than currently accepted standards of care. CONCLUSION Further studies are needed to optimize parameters, determine maximum efficacy, and provide long-term follow-up.
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7
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Combined Carbon Dioxide Laser with Photodynamic Therapy for Nodular and Superficial Basal Cell Carcinoma. Ann Plast Surg 2014; 73:552-8. [DOI: 10.1097/sap.0b013e3182773ed2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Superpulsed CO 2 Laser with Intraoperative Pathologic Assessment for Treatment of Periorbital Basal Cell Carcinoma Involving Eyelash Line. Dermatol Res Pract 2014; 2014:931657. [PMID: 25371667 PMCID: PMC4211181 DOI: 10.1155/2014/931657] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/14/2014] [Accepted: 09/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Periorbital basal cell carcinoma (BCC) is considered a high risk case because it is associated with high rate of recurrence and complication. Superpulsed CO2 laser with intraoperative pathologic assessment could be an alternative and appropriate treatment for periocular lesions where Mohs micrographic surgery is not available. Objective. To evaluate the efficacy of superpulsed CO2 laser therapy with intraoperative pathologic assessment on periocular BCC involving eyelash line. Method. This follow-up study was performed on 20 patients with a total of 21 BCC lesions that were pathologically documented. Firstly, debulkation of tumoral mass was done by curettage. Then, irradiation and intraoperative pathologic evaluation were done by concurrent CO2 laser. The patients were followed up for a period of 36 months. Results. Out of 21 lesions, the nodular type accounted for 15 (71.4%) lesions, and 12 (57.1%) lesions were seen in the lower lid as the most common clinical type and site involvement. Twenty BCC lesions (95.2%) were treated after one session. Damage to eyelash was seen in 2 (10%) patients, but ectropion and other complications were not seen in any patient. Conclusion. Treatment with superpulsed CO2 laser and intraoperative pathologic evaluation for periorbital BCC lesions much close to conjunctiva could be an effective method with minimal complications without major danger of recurrence. This modality can be used with care in the inner canthus and high risk pathologic lesions.
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Nicoli F, Balzani A, Gentile P, Lazzeri D, Di Pasquali C, Nicoli M, Bocchini I, Cervelli V. Squamous Cell Carcinoma Developing after CO2 Laser Resurfacing. J Cutan Med Surg 2013; 17:139-42. [DOI: 10.2310/7750.2012.12066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Skin resurfacing with the carbon dioxide (CO2) laser is currently a popular means of improving rhytides and scars and has been reported useful in the treatment for photodamaged skin, including precancerous and benign skin lesions, as well as superficial benign pigmented lesions. Methods: We describe a 68-year-old man who developed rapid squamous cell carcinoma (SCC) on the resurfaced areas 3 weeks following CO2 laser resurfacing. Results: Rapid occurrence of SCC should be considered a rare complication, and we recommend carefully considering CO2 laser resurfacing after excision of an SCC and surveying any cancer recurrences. Conclusions: We report a rare complication of CO2 laser resurfacing. This report suggests that additional work in this area is warranted.
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Affiliation(s)
- Fabio Nicoli
- From the Department of Plastic and Reconstructive Surgery, “Policlinico Casilino” University of Tor Vergata in Rome, Italy; Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy; and Department of Immunology, “La Sapienza” University, Rome, Italy
| | - Alberto Balzani
- From the Department of Plastic and Reconstructive Surgery, “Policlinico Casilino” University of Tor Vergata in Rome, Italy; Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy; and Department of Immunology, “La Sapienza” University, Rome, Italy
| | - Pietro Gentile
- From the Department of Plastic and Reconstructive Surgery, “Policlinico Casilino” University of Tor Vergata in Rome, Italy; Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy; and Department of Immunology, “La Sapienza” University, Rome, Italy
| | - Davide Lazzeri
- From the Department of Plastic and Reconstructive Surgery, “Policlinico Casilino” University of Tor Vergata in Rome, Italy; Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy; and Department of Immunology, “La Sapienza” University, Rome, Italy
| | - Camilla Di Pasquali
- From the Department of Plastic and Reconstructive Surgery, “Policlinico Casilino” University of Tor Vergata in Rome, Italy; Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy; and Department of Immunology, “La Sapienza” University, Rome, Italy
| | - Marzia Nicoli
- From the Department of Plastic and Reconstructive Surgery, “Policlinico Casilino” University of Tor Vergata in Rome, Italy; Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy; and Department of Immunology, “La Sapienza” University, Rome, Italy
| | - Ilaria Bocchini
- From the Department of Plastic and Reconstructive Surgery, “Policlinico Casilino” University of Tor Vergata in Rome, Italy; Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy; and Department of Immunology, “La Sapienza” University, Rome, Italy
| | - Valerio Cervelli
- From the Department of Plastic and Reconstructive Surgery, “Policlinico Casilino” University of Tor Vergata in Rome, Italy; Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy; and Department of Immunology, “La Sapienza” University, Rome, Italy
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Brightman L, Warycha M, Anolik R, Geronemus R. Do lasers or topicals really work for nonmelanoma skin cancers? ACTA ACUST UNITED AC 2011; 30:14-25. [PMID: 21540017 DOI: 10.1016/j.sder.2011.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Novel strategies are urgently needed to address the millions of nonmelanoma skin cancers treated in the United States annually. The need is greatest for those patients who are poor surgical candidates or those prone to numerous nonmelanoma skin cancers and therefore at risk for marked disfigurement. Traditional treatment strategies include electrosurgery with curettage, radiation therapy, cryotherapy, excision, and Mohs micrographic surgery. Alternatives to traditional treatment, including topical medications and light or laser therapies, are becoming popular; however, there are various degrees of efficacy among these alternative tactics. These alternatives include topical retinoids, peels, 5-fluorouracil, imiquimod, photodynamic therapy, and lasers. The purpose of this paper is to review the available data regarding these alternative strategies and permit the reader to have a sense of which therapies are reasonable options for care.
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Affiliation(s)
- Lori Brightman
- Laser & Skin Surgery Center of New York, 317 East 34th Street New York, NY 10016, USA.
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Helbig D, Simon JC, Paasch U. Photodynamic therapy and the role of heat shock protein 70. Int J Hyperthermia 2011; 27:802-10. [PMID: 21966972 DOI: 10.3109/02656736.2011.569966] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Doris Helbig
- University of Leipzig, Department for Dermatology, Venereology and Allergology, Germany.
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Prstojevich SJ, Nierzwicki BL. Treatment options for premalignant and malignant cutaneous tumors. Oral Maxillofac Surg Clin North Am 2007; 17:147-60, v. [PMID: 18088774 DOI: 10.1016/j.coms.2005.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Whenever possible, surgical excision of skin cancers should be the gold standard of treatment. There are many considerations when choosing one treatment modality over another. These include the lesion's location, the surgeon's experience and comfort level, the patient's health status and their potential compliance, access to available technology, and economic considerations for the patient and the provider. Regardless of the type of therapy, all forms of treatment share the following goals: complete disease cure, preservation of normal tissue, preservation of function, and optimal cosmesis.
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Affiliation(s)
- Steven J Prstojevich
- Department of Oral and Maxillofacial Surgery, University of Missouri-Kansas City, Truman Medical Center, 2301 Holmes Street, Kansas City, MO 64108, USA.
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Combined CO2 Laser With Photodynamic Therapy for the Treatment of Nodular Basal Cell Carcinomas. Ann Plast Surg 2007; 59:484-8. [DOI: 10.1097/sap.0b013e3180338536] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Iyer S, Bowes L, Kricorian G, Friedli A, Fitzpatrick RE. Treatment of basal cell carcinoma with the pulsed carbon dioxide laser: a retrospective analysis. Dermatol Surg 2004; 30:1214-8. [PMID: 15355363 DOI: 10.1111/j.1524-4725.2004.30378.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Treatment options for basal cell carcinoma include surgical excision, cryotherapy, radiation, photodynamic therapy, Moh's micrographic surgery, and topical treatment with 5-fluorouracil and immunomodulators such as imiquimod. Resurfacing and ablation with a CO(2) laser (UltraPulse, Coherent Inc.) may present an attractive and effective treatment option in the management of these cutaneous cancers. We demonstrate the efficacy and safety of the UltraPulse CO(2) in the treatment of basal cell carcinomas of the skin. METHODS We performed a retrospective chart review of 23 patients treated with the UltraPulse CO(2) laser. A total of 61 biopsy-proven superficial and nodular basal cell carcinomas without prior treatment were included in the study. The patients were followed postoperatively for a period of 15 to 85 months (mean 41.7 months) and assessed for clinical recurrence. RESULTS Of the 61 tumors treated, clinical recurrence was observed in two cases (3.2%). Adverse effects included significant hypertrophic scarring in one patient and hypopigmentation in one patient. CONCLUSIONS Destruction of superficial and nodular basal cell carcinomas may be accomplished successfully and safely with the UltraPulse CO(2) laser with a cure rate of 97%.
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Affiliation(s)
- Shilesh Iyer
- Dermatology Associates of San Diego County, Skin and Laser Surgery Center of La Jolla, La Jolla, California 92037, USA
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15
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Treatment of Basal Cell Carcinoma with the Pulsed Carbon Dioxide Laser. Dermatol Surg 2004. [DOI: 10.1097/00042728-200409000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Ammirati CT, Ioffreda MD, Hruza GJ. Malignant tumors of the keratinocytes and adnexae. Facial Plast Surg Clin North Am 2004; 11:141-63. [PMID: 15062270 DOI: 10.1016/s1064-7406(02)00042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Christie T Ammirati
- Department of Dermatology, Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033, USA.
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17
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Marmur ES, Schmults CD, Goldberg DJ. A Review of Laser and Photodynamic Therapy for the Treatment of Nonmelanoma Skin Cancer. Dermatol Surg 2004; 30:264-71. [PMID: 14871220 DOI: 10.1111/j.1524-4725.2004.30083.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of laser and light sources used alone and in conjunction with photodynamic therapy (PDT) for the treatment of nonmelanoma skin cancers (NMSCs) remains unclear. PDT is a newly accepted treatment option for actinic keratoses (AKs) with clearance rates comparable to 5-flourouracil. The purpose of this study was to review literature pertaining to the use of light-emitting technologies and PDT for the treatment of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and AKs. METHODS A National Library of Medicine PubMed Internet search of English-language journals was performed using the terms laser, PDT, BCC, SCC, and AK. The search encompassed all English-language clinical trials on human subjects from the mid-1960s to the present using laser and light source therapy and/or topical aminolevulinic acid. Articles were excluded if they contained fewer than 10 patients, had a follow-up time of less than 1 month, used intravenous photosensitizers, or were review articles. RESULTS A total of 20 papers were included for review (10 for BCC, 4 for AK, and 6 for SCC). Follow-up for these patients ranged from 1 to 36 months. Clearance rates were reported up to 100% for superficial BCCs, AKs, and SCC in situ, and lower (8%) for more invasive SCC. Recurrence rates ranged from to 0% to 31% for superficial BCCs, 16% to 31% for AKs, 0% to 52% for SCC in situ, and 82% for invasive SCC. CONCLUSION Precise PDT and laser clearance and recurrence rates for superficial and nodular BCC and SCC treated with laser and PDT are not yet known. From the available data, it appears that PDT may be capable of achieving clearance rates comparable to radiation therapy for BCC. However, with current technology, PDT treatment of BCC remains inferior to surgical excision and Mohs surgery, for which recurrence rates have been reported to be less than 10%. The reported clearance rates currently limit the usefulness of PDT and laser therapy. However, multiple treatments and the use of penetration enhancers may significantly increase the efficacy of 5-aminolevulinic acid-PDT. With regard to SCCs, the risk of metastatic disease restricts the use of laser and PDT. Studies are currently underway with new light sources, photosensitizers, and various therapeutic regimens. At this time, because the reported recurrence rates are significantly higher than those achieved with standard therapies, laser and PDT should be reserved for only those patients who cannot undergo surgical therapy for BCC and SCC.
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Affiliation(s)
- Ellen S Marmur
- Skin Laser and Surgery Specialists of NY/NJ, Hackensack, New Jersey, USA
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Hedelund L, Haedersdal M, Egekvist H, Heidenheim M, Wulf HC, Poulsen T. CO2 laser resurfacing and photocarcinogenesis: An experimental study. Lasers Surg Med 2004; 35:58-61. [PMID: 15278929 DOI: 10.1002/lsm.20067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES To examine whether carbon dioxide (CO2) laser treatment has a carcinogenic potential or may influence ultraviolet (UV)-induced carcinogenesis. STUDY DESIGN/MATERIALS AND METHODS Hairless mice (n = 211) were treated with a Sharplan CO2 laser with FeatherTouch scanner. Simulated solar irradiations were administrated either pre-operatively or pre- and post-operatively. Weekly clinical assessments of skin tumors were performed blinded during the entire observation period of 12 months. RESULTS No tumors appeared (a) in mice just treated with CO2 laser, (b) in mice exposed to UV irradiation only before CO2 laser treatment or (c) in untreated control mice. Tumors developed in CO2 laser treated mice that were exposed to UV-irradiation both pre- and post-operatively and in UV-irradiated control mice. The time to first, second, and third tumors ranged from 18 to 20 weeks and no significant differences were demonstrated. CONCLUSIONS CO2 laser treatment does not have a carcinogenic potential in itself, nor does CO2 laser treatment influence UV-induced carcinogenesis.
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Affiliation(s)
- Lene Hedelund
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark.
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Ultrapulse CO2 Used for the Successful Treatment of Basal Cell Carcinomas Found in Patients with Basal Cell Nevus Syndrome. Dermatol Surg 2002. [DOI: 10.1097/00042728-200203000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nouri K, Chang A, Trent JT, Jiménez GP. Ultrapulse CO2 used for the successful treatment of basal cell carcinomas found in patients with basal cell nevus syndrome. Dermatol Surg 2002; 28:287-90. [PMID: 11896785 DOI: 10.1046/j.1524-4725.2002.01080.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Basal cell nevus syndrome (BCNS) is an inherited condition marked by multiple basal cell carcinomas (BCCs) associated with several other abnormalities. Various treatment modalities have been used to eradicate these tumors. However, recurrences and scarring limit their use. OBJECTIVE To evaluate the treatment of multiple BCCs associated with BCNS. METHODS We describe three cases of BCNS in which multiple BCCs were effectively treated with ultrapulse CO2 laser. Postoperative Mohs micrographic surgical sections (thin sections looking for residual tumor) verified complete histologic clearance of the tumors. RESULTS All three patients were effectively treated with ultrapulse CO2 laser. Minimal scarring was noted at follow-up. CONCLUSION Ultrapulse CO2 laser can be used to effectively treat small BCCs in low-risk areas associated with BCNS with minimal posttreatment scarring.
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Affiliation(s)
- Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA.
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Karrer S, Szeimies RM, Hohenleutner U, Landthaler M. Role of lasers and photodynamic therapy in the treatment of cutaneous malignancy. Am J Clin Dermatol 2002; 2:229-37. [PMID: 11705250 DOI: 10.2165/00128071-200102040-00004] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Tumor therapy is not a common indication for the use of lasers, as it is in the treatment of benign vascular skin lesions, since many alternative treatment modalities exist. However, certain patients may benefit from laser therapy of premalignant and malignant skin tumors. Skin tumors can be treated by laser excision, laser coagulation, laser vaporization, or photodynamic therapy (PDT). For these purposes, the carbon dioxide laser, the neodymium:yttrium aluminum garnet laser and the argon laser are particularly suitable. PDT is a therapeutic approach based on the photosensitization of the target tissue by topical or systemic photosensitizers and subsequent irradiation with light from a laser or a lamp inducing cell death via generation of reactive oxygen species. Laser therapy and PDT have shown good results in the curative treatment of actinic keratoses, superficial basal cell carcinoma, Bowen's disease and cheilitis actinica. However, they are not recommended for primary malignant melanoma and invasive squamous cell carcinoma. In some patients, lasers and PDT might also be used effectively for the palliative treatment of cutaneous metastases. In selected patients, lasers and PDT may offer some advantages over routine procedures, e.g. reduction of scarring and better cosmetic results. However, when treating invasive tumors with curative intention, one has to bear in mind the lack of histologic control and the limited depth of tissue penetration of most laser and PDT therapies.
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Affiliation(s)
- S Karrer
- Department of Dermatology, University of Regensburg, Regensburg, Germany.
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