The pulsed dye laser for the treatment of basal cell carcinoma

Abstract

Basal cell carcinomas (BCC) have a specialized microvasculature system that can be targeted by the 585-nm pulsed dye laser (PDL) utilizing the theory of selective photothermolysis. Seven volunteers with nine well-defined, biopsy-proven BCCs, were treated with the PDL (585-nm wavelength, a single 450-μs pulse, 7-mm spot size, and 9.0 J/cm(2) energy). The lesions, along with a 4-mm border of normal skin were treated. Pain assessment was carried out immediately after the laser treatment. A deep shave biopsy with histological examination occurred 4 weeks after the laser treatment. Pain was assessed on a scale of 0 (no pain) to 10 (worst pain possible). The average patient score was 2.1 (range 1-4). On histology, 5/9 (55.6%) sites demonstrated no evidence of BCC; however, 4/9 (44.4%) sites showed residual BCC. Although the PDL was able to clear over half of the BCCs in this study, there was an unacceptably high persistence rate of 44.4%. The PDL did not achieve the clearance rate that can be attained with current standard BCC treatment modalities. At this time, we do not recommend that a single treatment with the 585-nm PDL can be used as a primary therapy for BCC.

Confocal microscopy to guide Erbium:yttrium aluminum garnet laser ablation of basal cell carcinoma: anex vivofeasibility study

“…[3][4][5] Laser treatment is suitable for certain types of patients such as those who may have multiple BCCs due to underlying hereditary disorders, excessive sun exposure or longterm immunosuppression, or those who may not tolerate surgical procedures, or those who may have low tolerance for the inflammatory side effects of topical therapies. [5][6][7][8] Laser ablation, e.g., is effective for treating superficial and nodular BCCs. [9][10][11] The treatment is relatively quick and convenient to perform in a single patient visit, and is minimally invasive, with finely controlled micrometer-level removal of tissue, reduced bleeding, scarring and infection, quicker recovery, and better cosmetic outcome.…”

Treatment of basal cell carcinoma using a combination of pulsed dye laser and imiquimod – Case report and review

“…Some studies reported CR rates ≥ 75%, which is acceptable [16,18], whereas in the remaining studies the CR rates were lower, ranging between 62% and 14% [13,14,17,19]. The number of PDL sessions is decisive for the treatment outcome: Amongst the 104 BCC treated with a 595-nm device, only 6/13 (CR: 46%) were cleared after a one-session scheme as opposed to 69/91 (CR: 76%) of the tumors treated with multiple 3-5 sessions (p = 0.0432; Fisher's exact test).…”

“…However, efficacy assessment of the PDL-based approach is obscured by the diversity of treatment parameters employed in the existing studies, as well as the methods applied to measure treatment outcomes (clinical follow-up or histopathological evaluation of completely excised tumors taken at different time intervals after PDL treatment). Moreover, in some studies only one PDL treatment session was allowed [13,14,19], whereas in the others, 3-5 sessions were planned on different days [15][16][17][18]20]. Overall, 81/120 (67.5%) treated tumors have been assessed as complete responders (CR).…”

“…Seven small studies were identified from the literature review that have reported results on the treatment of BCCs with vasculature targeting PDL devices working at 585 nm [13,14] or 595 nm [15][16][17][18][19][20] (Table 1). Data from a total of 120 BCC treatments with monomodal PDL (68 trunk or extremities and 52 face tumors) with four different PDL devices are available ( Table 1).…”

Perspectivas de futuro en láseres, nuevas tecnologías y nanotecnología en dermatología

“…Publicaciones recientes muestran la eficacia de los láseres vasculares en el tratamiento del carcinoma basocelular [46][47][48][49][50] . Sin embargo, se postula que esta técnica podría tener el riesgo de que las posibles recidivas muestren un crecimiento multifocal, de modo parecido a lo que ocurre con las recidivas después de la crioterapia.…”