There are currently many available treatments for dealing with actinic keratoses (pre-cancerous skin lesions), squamous cell, and basal cell carcinomas. These conditions can be treated topically with Aldara or Imiquimod creams, cryotherapy, or chemical peels. But laser treatment is really starting to come into its own as an option now – especially for eliminating multiple lesions. Dermatologists are trying out different lasers and various settings to see which techniques offer the best results with the fewest side effects.
CO2 lasers are used to target the epidermis and the upper layer of the dermis, heating it enough to eliminate abnormal squamous cells. The depth of resurfacing treatment can be varied based on the type of cancer (basal cell or squamous cell) that is present. It’s not necessarily the right approach to use when the tumor is thick or if it penetrates deep into the skin, but it may be used in combination with curettage for some patients. So far, laser ablation appears to have the same success rate (about 80-90%) and the same remission rate at 5 years as chemical peels and topical creams.
Basal cell carcinomas (BCCs) tend to involve a number of small blood vessels. Coagulation of these vessels cuts off the blood supply to the tumor. This can be achieved with a pulsed laser that is set to selectively heat vascular tissue while leaving the surrounding skin alone. Such a targeted approach to removal for BCCs may create less post-procedure scarring than surgical excision. Follow up with biopsy may still be needed to verify clearance of the abnormal cells.
Fractional lasers that cause less skin damage than traditional ablative lasers are proving useful for controlling actinic keratoses (AKs). This variety of laser is suitable for full facial skin rejuvenation which means it may also catch other AKs before they reach the visible stage. Patients enrolled in a pilot study all reported at least “good” results with 3 out of 4 ranking their results as “excellent”. Multiple treatments were sometimes necessary to achieve the desired results. Larger trials with longer follow up periods will be needed to determine whether results are maintained beyond the 9 month mark.