CARLSBAD, USA – The idea of using non-ablative fractional lasers to reduce the risk of non-melanoma skin cancer has gained traction in recent years, and a key 2017 publication laid the groundwork for current approaches, according to the Dra. Elizabeth Tanzi.[1]
In the article published in Moleculeshe Dr. Mike Kemp, Ph. D. and the Dr. Jeffrey Bryant Travers, Ph.D., from Wright State University in Dayton, United States, and the Dr. A.S. Dan F. Spandau, Ph.D. D., from Indiana University School of Medicine in Indianapolis, USA, showed that elderly skin responds to ultraviolet B (UVB) light differently than young skin due to differences in levels of insulin-like growth factor 1 (IGF-1) produced by the skin. “As we age, our fibroblasts become senescent, inactive,” said Dr. Tanzi, associate clinical professor of dermatology at The George Washington University, in Washington DC, USA, at the symposium Controversies and Conversations in Laser and Cosmetic Surgery“They don’t produce as many growth factors, particularly insulin-like growth factor 1, and so we don’t stimulate responses. We need more of our growth factors.”[2]
In subsequent work, Dr. Travers, Dr. Spandau and their colleagues found that using fractional laser resurfacing or dermabrasion to wound the skin can result in increased dermal levels of insulin-like growth factor 1 and normalization of the abnormal procarcinogenic UV response associated with geriatric skin, a treatment that has the potential to prevent nonmelanoma skin cancer. That study “was the epiphany” in fostering interest among researchers in the field of lasers and medicine, Dr. Tanzi said.[3]
In a retrospective cohort study, the Dr. Mathew Avramand colleagues reviewed patients with a history of facial keratinocyte carcinoma who were treated at Massachusetts General Hospital in Boston, USA, between 2005 and 2021. The study population included 43 patients treated with 1,927- or 1,550-nm fractional nonablative laser (NAF) and 52 matched controls. The rate of subsequent development of facial keratinocyte carcinoma was 20.9% in patients treated with nonablative fractional laser and 40.4% in control subjects (relative risk [RR]: 0,52; p = 0,049).[4]
During a separate presentation at the symposium, Dr. Avram, director of lasers and cosmetics at Massachusetts General Hospital in Boston, said that when he and his colleagues controlled for age, sex, and skin type, controls were 2.65 times more likely to develop new facial keratoconus compared with people treated with non-ablative fractional laser (p = 0.0169). “This enhanced effect was seen with the 1,550-nm device compared with the 1,927-nm device,” said Dr. Avram. “The study shows us that the 1,550-nm/1,927-nm non-ablative fractional laser wavelength may have a protective effect for patients with a history of keratinocyte carcinoma, but the role of each wavelength remains to be determined. We also need a prospective, controlled study to verify the results.”
In an ongoing study presented for the first time at the Annual Congress of the American Society for Dermatologic Surgery (ASDS) study in 2023, Dr. Tanzi and colleagues enrolled 15 patients ≥55 years of age to evaluate the restoration of physiologic features and biomarkers in skin treated with 25% trichloroacetic acid (TCA) plus either the 1550-nm or 1927-nm nonablative fractional laser. Four sites on the back were treated, and biopsies were taken at baseline and at 3 months posttreatment. The protocol included 25% trichloroacetic acid to mottled frosting, with the 1550-nm device set at level 6 at 70 mJ and the 1927-nm device set at level 8 at 20 mJ. Immunohistochemical stains are pending; however, physiologic changes were observed.
Three months after a single treatment, areas treated with 1,927 nm showed statistically significant elongation of fibroblasts (consistent with younger fibroblasts) on histology. “While this is not a large study, it supports the growing body of research showing that we are improving the health of our patients’ skin with certain types of laser treatments, not just beautifying it,” said Dr. Tanzi.
Dr. Tanzi disclosed that she serves on the advisory board of AbbVie/Allergan and Sciton. She also serves as a consultant for Alastin/Galderma, Candesant Biomedical, Cytrellis, Inc., Revance, and Solta Medical. Dr. Avram disclosed that he receives intellectual property royalties and holds stock options from Cytrellis, Inc. He also serves as a consultant for Allergan and holds stock options from BAI Biosciences, Sofwave, and La Jolla NanoMedical.
This content was originally published in the English edition of Medscape.
