Laser treatment of non melanoma skin cancer

Abstract

Laser treatment of non-melanoma skin cancer was introduced into current British Guidelines update. We provide an update of our work since that period and the outlook to the future. Basal cell carcinoma (BCC) is the commonest cancer. Recommended margins of excisional surgery are associated with a high clearance rate, at the expense of significant functional and aesthetic morbidity, especially within the T-zone or for extensive lesions. Our published data combining ultra-pulsed 10,600nm laser combined with VPL (variably pulsed light) activated m-amino laevulanatic acid to be a cost-effective high success rate option in patients with biopsy proven BCC, even in extensive lesions covering up to 1% of total body surface area, and up to 3.8mm (1.38 ± 0.695cm, mean± standard deviation) in biopsy-proven depth. At the five-year follow-up mark, 93.6% of treated areas remained free of recurrence. Nodular basal cell carcinoma was the most common subtype (41.5%). A mean tumour depth greater than 2± 0.872mm was significantly associated with recurrence (Mann–Whitney, p=0.0487). For a service delivered through the NHS at 2015 prices, we report a 43% saving, equating to a saving of £235 per basal cell carcinoma or a national annualised saving of £70 million by 2025 for the NHS. Conclusion Our published results suggest that CO2-assisted photodynamic therapy is non-inferior to excision but may offer better functional and cosmetic preservation at a fraction of the direct like for like cost of operative surgery. Despite very high set up cost, a steep learning curve, and a long training time further research is warranted.