Laser Treatment for Non-Melanoma Skin Cancer: A Systematic Review and Meta-Analysis.

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.

• Authors: Eran Sharon, Igor Snast, Moshe Lapidoth, Ran Kaftory, Daniel Mimouni, Emmilia Hodak, Assi Levi
• Journal: American journal of clinical dermatology (Am J Clin Dermatol) Vol. 22 Issue 1 Pg. 25-38 (Jan 2021) ISSN: 1179-1888 [Electronic] New Zealand
• PMID: 32930983 (Publication Type: Evaluation Study, Meta-Analysis, Systematic Review)

Topics

• Biopsy
• Bowen's Disease (diagnosis, epidemiology, pathology, surgery)
• Carcinoma, Basal Cell (diagnosis, epidemiology, pathology, surgery)
• Cicatrix (epidemiology, etiology)
• Cohort Studies
• Follow-Up Studies
• Humans
• Hypopigmentation (epidemiology, etiology)
• Laser Therapy (adverse effects, instrumentation, methods, statistics & numerical data)
• Lasers, Dye (adverse effects)
• Lasers, Gas (adverse effects)
• Lasers, Solid-State (adverse effects)
• Neoplasm Recurrence, Local (diagnosis, epidemiology, pathology)
• Neoplasm, Residual
• Randomized Controlled Trials as Topic
• Skin (pathology, radiation effects)
• Skin Neoplasms (diagnosis, epidemiology, pathology, surgery)
• Skin Pigmentation (radiation effects)
• Treatment Outcome