An Update on Laser Therapy for Basal Cell Carcinoma

Abstract

Basal Cell Carcinoma (BCC) is the most common form of skin cancer worldwide with more than two million cases diagnosed annually in the United States. Although this tumor grows slowly and rarely metastasizes, it can cause significant destruction of local tissue and result in cosmetic and functional morbidity. Standard treatments for BCC include surgical excision, Mohs Micrographic Surgery, cryosurgery, electrodessication and curettage, and topical modalities. Surgical treatments often result in disfigurement, while topical therapies frequently result in recurrence. Thus, there is a need for alternative non-surgical options that are effective and have a lower risk of side effects than existing therapies. This has led to the investigation of laser therapy for the treatment of BCC. Laser treatment of BCC can be based on selective photothermolysis of the tumor vasculature which has the advantage of minimal damage to normal tissue (1,2). The microvasculature of BCC is significantly larger compared to normal skin (3,4), allowing for selective targeting of BCC with preservation of surrounding structures. Destruction of the tumor's vascular supply seems to lead to tumor regression. However, a mass heating effect may play a role in destruction of the tumor at higher energies. The ideal wavelength for the treatment of BCC has yet to be determined. Preliminary investigations for laser treatment of BCC have primarily been with the pulsed-dye laser (PDL). A pilot study with the PDL reported a 92% regression rate of nodular BCC less