Laser Treatment to Lower NMSC Risk Gaining Ground

CARLSBAD, California — The idea of using nonablative fractional lasers to reduce the risk of nonmelanoma skin cancer has gained support in recent years, and a key 2017 publication laid the groundwork for current approaches, according to Elizabeth Tanzi, MD.
In the article, which was published in Molecules, Mike Kemp, PhD, and Jeffrey Bryant Travers, MD, PhD, at Wright State University, Dayton, Ohio, and Dan F. Spandau, PhD, at Indiana University School of Medicine, Indianapolis, demonstrated that geriatric skin responds to ultraviolet B (UVB) differently than young skin because of differences in insulin-like growth factor 1 (IGF-1) levels produced by dermal fibroblasts. “As we age, our fibroblasts become senescent, inactive,” Tanzi, associate clinical professor of dermatology at George Washington University, Washington, DC, said at the Controversies and Conversations in Laser and Cosmetic Surgery symposium. “They don’t make as many growth factors, particularly IGF-1, and therefore we don’t stimulate the responses. We need more of our growth factors.”
In later, separate work, Travers, Spandau, and colleagues found that using dermabrasion or fractionated laser resurfacing to wound the skin can result in increased dermal IGF-1 levels and normalization of the abnormal pro-carcinogenic UV response associated with geriatric skin — a treatment that has the potential to prevent nonmelanoma skin cancer. That study “was the epiphany” for fostering interest among researchers in the field of lasers and medicine, Tanzi said.
In a retrospective cohort study, Mathew Avram, MD, JD, and colleagues reviewed patients with a history of facial keratinocyte carcinoma (KC) who were treated at Massachusetts General Hospital in Boston between 2005 and 2021. The study population included 43 patients treated with either the 1927- or the 1550-nm nonablative fractional laser (NAFL) and 52 matched controls. The rate of subsequent facial KC development was 20.9% in NAFL-treated patients and 40.4% in control subjects (relative risk, 0.52; P = .049). 
During a separate presentation at the meeting, Avram, director of lasers and cosmetics at Massachusetts General Hospital, Boston, Massachusetts, said that when he and his colleagues controlled for age, gender, and skin type, controls were 2.65 times more likely to develop new facial KC compared with those treated with NAFL (P = .0169). “This enhanced effect was seen with the 1550-nm device compared with the 1927-nm device,” Avram said. “The study shows us that 1550-nm/1927-nm NAFL may have a protective effect for patients with a history of KC, but the role of each wavelength is to be determined. We also need a prospective, controlled study to verify the results.” 
In an ongoing study first presented at the 2023 annual meeting of the American Society for Dermatologic Surgery, Tanzi and colleagues enrolled 15 patients aged ≥ 55 years to evaluate the restoration of physiologic features and biomarkers in skin treated with 25% trichloroacetic acid (TCA), plus the 1550-nm or 1927-nm NAFL. Four sites on the back were treated and biopsies were taken at baseline and at 3 months post treatment. The protocol involved TCA 25% to speckled frost, with the 1550-nm device set to level 6 at 70 mJ and the 1927-nm device set to level 8 at 20 mJ. Immunohistochemical stains are still pending; however, physiologic changes were noted.
Three months after a single treatment, the 1927-nm treated areas showed statistically significant elongation of fibroblasts (consistent with younger fibroblasts) on histology. “Although not a large study, it supports the growing body of research that demonstrates we are improving the health of our patients’ skin with certain types of laser treatments, not just beautifying it,” Tanzi said. 
Tanzi disclosed being a member of the advisory board for AbbVie/Allergan and Sciton. She is also a consultant for Alastin/Galderma, Candesant Biomedical, Cytrellis, Inc., Revance, and Solta Medical. Avram disclosed that he receives intellectual property royalties from and holds stock options in Cytrellis, Inc. He is also a consultant to Allergan and holds stock options in BAI Biosciences, Sofwave, and La Jolla NanoMedical.
 
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