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Advances in Skin Cancer Treatment Options

Advances in research and technology allows a wider range of non-surgical options for the prevention & treatment of skin cancer.

As a dedicated team of dermatologists at the forefront of surgical and non-surgical dermatology, we are committed to enhancing patient outcomes through providing a range of specialised skin cancer treatment options in our community. We value collaborating with our GP and GP skin cancer specialist colleagues to provide best patient outcomes.

Early detection remains paramount in the optimisation of skin cancer outcomes, and we work together with our colleagues to detect early and offer a wide range of treatment options to patients.

Surgical options include simple excisions, flap and graft closures, curettage and cryosurgery.

Beyond surgery, we also offer advanced non-surgical treatments such as:

  • Photodynamic therapy (PDT) using advanced laser assisted drug delivery
  • Non-ablative fractional lasers
  • Ablative lasers

When are different options most suitable?

We are often asked when we would recommend different treatment options and why a range of options are beneficial for the patient. Below we have summarised how we approach the range of treatment options available with our patients, comparing the most common consideration of downtime, scarring/complications and cost.

Is it too late for a laser option?

Laser treatment is usually suitable for patients with actinic keratoses and many superficial malignancies. This also applies to actinic chelitis, in which it is often considered gold-standard treatment.

Superficial BCCs may be suitable for laser or laser + PDT. Nodular BCCs are still best managed with surgical excision.

Intraepidermal carcinoma may be treated with laser or laser + PDT, including on the lip when laser vermillionectomy is considered gold-standard treatment.

What part of the body can laser treatment be done?

We find that patients usually do not mind some scarring on certain parts of the body, but prefer laser and other non-surgical options, if appropriate, for cosmetically sensitive areas such as the face and neck.

Actinic chelitis or intraepidermal carcinoma (Bowen’s disease) of the lip is often treated by a laser vermillionectomy utilising the ablative Erbium:YAG or CO2 laser, usually with minimal scarring, disfigurement, or functional loss.

Does non-ablative fractionated laser treatment really prevent development of skin cancer?

Early treatment of actinic keratoses prevents them developing into skin cancers that require heavier treatments or surgery.

Recent research has provided promising results in the use of fractional non-ablative laser to reduce the burden of progression to keratinocyte malignancies, and may be a useful prophylactic tool in this field.

https://pubmed.ncbi.nlm.nih.gov/36728065

We always recommend that our patients receive a non-ablative fractional laser treatment intermittently in the harsh Queensland weather for skin health and prophylactic field treatment, and treat any actinic keratoses that appear over the year. A skin check is always required prior to laser treatment to ensure that any skin cancers that may be present are detected, biopsied and appropriately treated prior to preventative fractionated laser treatment.

What is PDT (with red/blue light or laser assisted delivery)?

Photodynamic therapy has been used for a long time for the successful treatment of skin cancer. This is a process whereby methyl aminolevulinate is applied to the skin and allowed to incubate for a certain period before activation through laser or light.

There are a range of ways that activation can occur, and deciding which type of activation to use will be influenced by the depth of penetration required,

Red light activation is moderately painful, full field treatment option.

Blue light activation is a less painful field treatment option which penetrates deeper into the skin but does not affect the surface as much as red light.

Laser activation will provide a more targeted and deeper treatment option, with more even/controlled treatment of the full field if required.

What Are CO₂ and Erbium Lasers?

By Dr Shobhan Manoharan, Laser & Aesthetic Dermatologist

As a laser and aesthetic dermatologist, I’m often asked by GPs about ablative lasers—particularly carbon dioxide (CO₂) and erbium:YAG lasers. While widely known for skin resurfacing and rejuvenation, these lasers also serve critical roles in managing actinic damage and certain skin cancers.

How Do They Work?

Both lasers target water as their chromophore:

  • CO₂ laser (10,600 nm): deeper penetration, more thermal damage, strong collagen stimulation.
  • Er:YAG laser (2,940 nm): more superficial ablation, less heat, faster recovery.

Both are used in either fully ablative or fractional modes. Fractional devices create microscopic columns of damage, allowing faster healing with lower risk and downtime.

CO₂ Laser for Sun Damage and Skin Cancer

Actinic Damage / Field Cancerisation

CO₂ laser resurfacing is an effective treatment for widespread actinic keratoses (AKs) and solar elastosis. It offers a “field therapy” approach, targeting clinically apparent and subclinical lesions.

  • Fractional CO₂ lasers improve texture and pigmentation while significantly reducing AK burden.
  • Laser treatment often improves patient adherence compared to prolonged topical therapies.

Waldman et al. (2020) found significant reduction in AK count in high-risk patients following fractional CO₂ resurfacing, with excellent tolerability and cosmetic results.

Superficial Non-Melanoma Skin Cancer (NMSC)

CO₂ lasers are used selectively for superficial basal cell carcinoma (sBCC) and Bowen’s disease, especially:

  • In elderly or medically unfit patients.
  • In areas where surgical excision would cause cosmetic or functional issues.

Laser ablation offers high cure rates for select lesions, particularly when histological diagnosis is already confirmed and lesion margins are well-defined.

Tierney et al. (2009) reported >90% clearance of sBCC with CO₂ laser ablation in a retrospective cohort, with minimal recurrence.

Clinical Considerations for GPs

  • Referral: Consider dermatology referral for patients with:
    • Multiple AKs or field cancerisation
    • Recurrent sBCC/Bowen’s in cosmetically sensitive sites
    • Preference to avoid long-term topical therapies
  • HSV Prophylaxis: CO₂ laser resurfacing can trigger herpes simplex reactivation—consider valaciclovir prophylaxis in at-risk patients.
  • Post-laser care: Includes wound care, sun protection, and monitoring for delayed healing or PIH (particularly in skin of colour).

CO₂ and Er:YAG lasers are versatile tools in dermatology. Their role in managing sun damage, actinic keratoses, and select superficial skin cancers offers GPs a broader therapeutic understanding, especially when surgical options are limited. Early referral can lead to excellent outcomes with minimal morbidity.

References

  1. Waldman RA, Arndt KA, Bolognia JL, et al. Fractional CO₂ laser resurfacing for field cancerization: A review and case series. Lasers Surg Med. 2020;52(6):499–507. https://pubmed.ncbi.nlm.nih.gov/32056342
  2. Tierney EP, Hanke CW, Petersen J. Ablative laser resurfacing for the treatment of superficial basal cell carcinoma: A review and retrospective study. Dermatol Surg. 2009;35(9):1400–1411. https://pubmed.ncbi.nlm.nih.gov/19320735
  3. Gonzalez S, Tannous Z. Laser treatment of nonmelanoma skin cancer. Skin Therapy Lett. 2002;7(6):1–4. https://pubmed.ncbi.nlm.nih.gov/12120247
  4. Khatri KA, Ross V, Grevelink JM, et al. Comparison of CO₂ laser and Er:YAG laser resurfacing: A clinical and histopathologic study. Lasers Surg Med. 1999;24(2):93–100. https://pubmed.ncbi.nlm.nih.gov/10094436
  5. Cohen PR, Schulze KE. Management of actinic keratoses: A comprehensive review. Dermatol Online J. 2021;27(9). https://pubmed.ncbi.nlm.nih.gov/34607797