Fractional lasers show promise in skin cancer prevention

Key takeaways:

• Lasers reduce photodamaged keratinocytes by stimulating regeneration of the skin.
• Lasers reduce risk for photocarcinogenesis by stimulating insulin-like growth factor signaling, repairing DNA damage.

Fractional lasers may be a promising new treatment option for the prevention of nonmelanoma skin cancer by promoting skin regeneration and stopping photocarcinogenesis, according to a study.

“Fractional lasers (FLs) are used to manage various dermatologic conditions including photoaging, scarring and dyspigmentation, and are currently being studied in the context of [nonmelanoma skin cancer (NMSC)] prevention due to their ability to modulate epidermal turnover and signaling molecules crucial for the skin’s protective response against UV,” Erika T. McCormick, BSc, of The George Washington University department of dermatology, and colleagues wrote.

FLs may be promising treatment options for NMSC prevention through two mechanisms of action, according to the researchers.

First, FLs can reduce the burden of photodamaged keratinocytes. FL-induced injury promotes extrusion of damaged keratinocytes, stimulating regeneration of the skin. This can contribute to a decrease in clinical and histologic signs of photodamage.

Second, FLs may reduce the risk for keratinocyte photocarcinogenesis by stimulating insulin-like growth factor signaling, repairing ultraviolet-induced DNA damage. In fact, one study referenced by the authors found that FL treatments increased insulin-like growth factor signaling in the skin by 60% and maintained results for 2 years post-treatment.

Both ablative and nonablative FLs (AFLs and NAFLs) may benefit NMSC prevention, according to the study.

“AFLs thermally ablate epidermal and dermal tissue in microthermal treatment zones, causing full-thickness skin injury in treated areas of actinic damage,” the authors explain. Data have shown that these lasers are comparable with other actinic keratoses (AK) management options, reducing these patches by 60% to 70% when used as a monotherapy.

AFLs also proved to assist the efficacy of photodynamic therapy. When used preceding photodynamic therapy, 92% of patients had a complete response compared with only 66% that used photodynamic therapy alone, according to the study.

NAFLs have a milder treatment effect, creating controlled dermal tissue injury without compromising the epidermis, according to the researchers.

Although the evidence is less clear than that found for AFLs, one prior study showed that NAFLs decreased AKs by 56%, although 83% of follow-up biopsies showed the AKs had returned.

On the other hand, the authors referenced another study that found NAFL monotherapy reduced AKs by 87% and maintained clearance in 86% of lesions.

Ultimately the authors believe that FL treatment is a promising strategy for NMSC prevention; however, further research is needed to establish consensus on protocols and procedures for treatment.