The Role of Laser Treatments in Preventing Skin Cancer

“The number one reason people come in for laser and light treatments is sun damage, freckles you get from the sun, and/or treating fine lines and wrinkles that you get as a result of sun exposure,” said Patricia Richey, MD, FAAD, director of Mohs surgery at Boston Medical Center in Massachusetts during a recent interview with Dermatology Times. “There are 2 different wavelengths in particular that we've looked at for prevention of skin cancers.”

Richey shared insights from her experience in the clinic and delving into research to utilize laser treatments to prevent skin cancer.

The Prevalence of Skin Cancer and Preventive Measures

"First of all, we know that skin cancer is the most common cancer in the US," Richey stated, emphasizing the widespread nature of this health issue.¹ Despite the high prevalence, she noted that significant strides have been made in both prevention and treatment. "We have amazing ways to treat skin cancers, but we know that while there are certain genetic risks that may put you at risk for skin cancers, and there are certain treatments, both topicals and lasers, that can help prevent them, UV exposure, so sun exposure is still, by far, kind of our number one biggest contributor."

Richey underscored the importance of reminding patients of preventive measures against UV exposure, recommending SPF 50 or greater with zinc oxide in it and wearing some protective clothing.

Advancements in Laser Treatments

Richey believes laser treatments are becoming an increasingly prominent tool in the prevention of skin cancer. Historically, most laser research focused on ablative lasers, which remove part of the epidermis. While effective, Richey noted the drawbacks and said, "It's a painful procedure. You need more downtime off of work, and because you're taking off pieces of the skin, it can lead to sort of pigmentary issues, and you can have some scarring."

Exploring Non-Ablative Fractional Lasers

According to Richey, a significant advancement in this field is the shift towards non-ablative fractional lasers. She explained, "More recently, I would say, in the past year and a half, there have been a bunch of different ways in which you can treat pre-skin cancers, actinic keratosis, and or treat the background skin to prevent skin cancers." These newer treatments offer reduced downtime and fewer side effects, making them more patient-friendly.

The 2 main wavelengths used in these lasers are the 1927 nanometer and the 1550 nanometer fractional non-ablative lasers. Richey elaborated, "The 1927 nanometer fractional, non-ablative laser is our resurfacing laser. So that's treating lentigines and brown spots. Then, a slightly deeper version of the fractional laser, the 1550 nanometer laser, is mostly heating up your dermis to produce this wound healing response." Both lasers have shown efficacy in preventing skin cancers while improving overall skin appearance and health.^2-3

Benefits for Skin Health and Diverse Skin Types

Richey highlighted the potential of these treatments in enhancing skin health and possibly reducing postoperative scarring. She noted, "When we do these fractional lasers, they increase something called insulin-like growth factor [IGF] in your skin. IGF is anti-carcinogenic, so we think maybe that's one of the mechanisms through which the laser prevents skin cancers, but it also helps your overall skin health. So that, mixed with this heating of your skin that creates a wound healing response may mean that your skin is better at healing, but we can't really say that definitively right now."

The effectiveness of non-ablative fractional lasers in diverse skin types is another critical advantage. Richey pointed out, "If you have someone who knows what they're doing with their settings, the 1550 nanometer in particular can be used quite safely in all skin types." This inclusivity is crucial because skin cancer can affect individuals of all skin tones, and historically, treatments have not always been suitable for darker skin types, especially since late diagnosis is common with darker skin.⁴

Long-Term Prevention and Future Prospects

Discussing the future of laser treatments in dermatology, Richey expressed optimism about their role in preventing skin cancer. "In the most recent studies, and this mostly came out of Matt Abram and Brian Hibler over at Mass Gen, they found that the people who got even just 1 of these non-ablative, fractional laser treatments were half as likely as their counterparts to get another skin cancer over a 6-year period," she shared.⁵

Current Limitations and Ongoing Research

While non-ablative fractional lasers show promise in prevention, Richey is cautious about their use in treating existing skin cancers. "I wouldn't necessarily at this point use lasers to treat what we know is a skin cancer on someone's face, but I do think that day is coming," she said. For now, traditional methods like Mohs surgery remain the gold standard for higher-risk tumors and those located on critical areas such as the face or hands."I see [non-ablative fractional lasers] as playing an amazing role in terms of skin cancer prevention. Again, not treating skin cancers, you're really doing an excision or Mohs surgery to a known basal cell or a squamous cell," she concluded.

References

1. US Department of Health and Human Services. The Surgeon General's call to action to prevent skin cancer. Washington (DC): Office of the Surgeon General (US); 2014. Skin Cancer as a Major Public Health Problem. Available from: https://www.ncbi.nlm.nih.gov/books/NBK247164/
2. Brauer JA, McDaniel DH, Bloom BS, Reddy KK, Bernstein LJ, Geronemus RG. Nonablative 1927 nm fractional resurfacing for the treatment of facial photopigmentation. J Drugs Dermatol. 2014;13(11):1317-1322.
3. Friedman P, Chapas A, Kilmer S, et al. Optimizing Outcomes With the 1550/1927 nm Dual Wavelength Non-Ablative Fractional Laser: Experienced User Recommendations. J Drugs Dermatol. 2021;20(11):1150-1157. doi:10.36849/jdd.6181
4. Gupta AK, Bharadwaj M, Mehrotra R. Skin Cancer Concerns in People of Color: Risk Factors and Prevention. Asian Pac J Cancer Prev. 2016;17(12):5257-5264. Published 2016 Dec 1. doi:10.22034/APJCP.2016.17.12.5257
5. Simple laser treatments may help prevent nonmelanoma skin cancer. News release. Massachusetts General Hospital. January 18, 2023. Accessed June 17, 2024. https://www.massgeneral.org/news/press-release/simple-laser-treatments-may-help-prevent-nonmelanoma-skin-cancer