Treatment of Nonmelanoma Skin Cancers Using Laser-Assisted Drug Delivery

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In their timely analysis of the use of laser devices for treatment of nonmelanoma skin cancers (NMSCs),1 the authors did not afford attention to the nascent technology of laser-assisted drug delivery (LADD). The advent of ablative fractional laser devices (AFXL) has allowed operators to create multiple channels of ablated tissue that act as conduits enhancing delivery of topical agents from epidermis to deeper cutaneous structures, while leaving large areas of the epidermis intact, facilitating rapid recovery and reducing postprocedural downtime.2,3
Previous studies have suggested pretreatment with AFXL can increase the transdermal delivery of a range of topical drugs used for treatment of NMSCs, including ingenol mebutate for actinic keratoses, 5-fluorouracil for squamous cell carcinoma in situ, and photosensitizers (aminolevulinic acid and methylaminolevulinic acid) used for photodynamic therapy (PDT) for actinic keratoses, Bowen disease, and basal cell carcinomas.4 Laser-assisted drug delivery for NMSCs results in increased effectiveness of a given concentration of the drug, as well as offers the possibility of decreasing incubation time before PDT, using a lower concentration of drug or reducing frequency of application to achieve an equivalent clinical result.4
As LADD is more widely practiced and results of larger comparative studies are more reported, the role of LADD in the management of NMSCs will become clearer.

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