Pulsed dye laser treatment benefits older adults with nonmelanoma skin cancer on hands

Key takeaways:

• While surgery remains the gold standard, two treatments with a 595 nm pulsed dye laser is a viable alternative for the fragile skin of older adult hands.
• Recurrence rates during treatment were 9.6%.

NEW ORLEANS — Having proven a low recurrence rate, two treatments of the 595 nm pulsed dye laser may be a viable therapy for nonmelanoma skin cancer on the hands of older adult patients, according to a poster presented here.

While the standard treatment for nonmelanoma skin cancer (NMSC) is surgery, the fragile skin and atrophy seen on the hands of older adults complicates this method. The 595 nm pulsed dye laser (PDL; Vbeam, Syneron-Candela) may offer an alternative treatment option for this patient population.

“PDL targets the vascular structures supplying the neoplasm and may damage the stroma of carcinoma,” Elliott Herron, BS, a student at the University of Alabama at Birmingham Heersink School of Medicine, and colleagues wrote in a poster presented at the American Academy of Dermatology Annual Meeting. “The depth of vessel coagulation with PDL is 0.65 mm to 1.2 mm. ... whereas epidermal thickness of the dorsal hand measures to approximately 0.2 mm.”

In this study, researchers performed a retrospective chart review of 124 nonmelanoma skin cancer cases on older adult hands that were treated with 595 nm PDL from 2009 to 2022. The laser was used on seven basal cell carcinomas (BCC) and 117 squamous cell carcinomas (SCC) with the “warts non-facial” setting, which includes 7 mm spot size, 12 joules, 1.5 millisecond and no cooling.

From 2009 to 2014, patients (mean age, 72 years; 56% men) were treated with one to two cycles of the PDL over 2 months; however, upon further review, researchers switched to two cycles in 2015. The average follow-up was 5.1 years.

Results showed that treatment with PDL yielded 12 post-treatment recurrences. Ten of these occurred in the 12 patients who received one treatment, whereas only two occurred in the 10 patients who received two treatments. The recurrence rate for one treatment was 15% and decreased to 3.5% with two treatments (OR = 5.403; 95% CI, 1.145-25.487).

The most common recurrence occurred in SCC cases which included in situ (6%) and other types of SCC (12%). In contrast, there were no recurring cases of BCC.

While the researchers called loss to follow-up inevitable, they added that the drop-out rate in the chart review was concerning.

Nevertheless, the authors concluded that this study proves the validity of 595 nm PDL in two treatment doses as a noninvasive NMSC treatment option on the hands of older adult patients.