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Published on: September 27, 2024
Facial resurfacing for nonmelanoma skin cancer prophylaxis
Basil M Hantash1, Daniel B Stewart, Zachary A Cooper
1Department of Dermatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
Objective:
To determine the effect of facial skin resurfacing for treatment of actinic keratoses (AKs) and prophylaxis against new primary basal and squamous cell carcinomas in individuals with previous nonmelanoma skin cancer (NMSC) or severe photodamage.
Design:
Randomized, prospective 5-year trial.
Setting:
Dermatology and otolaryngology clinics of a Veterans Affairs hospital.
Patients:
Thirty-four patients with a history of facial or scalp AKs or basal or squamous cell carcinoma were enrolled. Five of 7 eligible patients who declined study-related treatment were used as controls. Twenty-seven patients were randomized to 3 treatment arms; 3 patients were discontinued from the study.
Interventions:
Carbon dioxide laser resurfacing, 30% trichloroacetic acid peel, or 5% fluorouracil cream applied twice daily for 3 weeks.
Main Outcome Measures:
Reduction in the number of AKs was measured 3 months after treatment. The incidence of new NMSC in treated areas was assessed between January 1, 2001, and June 30, 2005. Times from baseline to diagnosis of first skin cancer were compared between the treatment and control groups.
Results:
Treatment with fluorouracil, trichloroacetic acid, or carbon dioxide laser resulted in an 83% to 92% reduction in AKs (P< or =.03), a lower incidence of NMSC compared with the control group (P<.001), and a trend toward longer time to development of new skin cancer compared with the control group (P=.07). However, no significant differences were noted among the treatment groups.
Conclusion:
All 3 modalities demonstrated benefit for AK reduction and skin cancer prophylaxis compared with controls and warrant further study in a larger trial.
Insights
Facial skin resurfacing with fluorouracil, trichloroacetic acid, or CO2 laser significantly reduced actinic keratoses (AKs) and nonmelanoma skin cancer (NMSC) incidence compared to controls. All treatments showed comparable efficacy for AK reduction and NMSC prevention.
Area of Science:
- Dermatology
- Oncology
- Medical Aesthetics
Background:
- Actinic keratoses (AKs) and nonmelanoma skin cancer (NMSC) are common skin conditions, particularly in individuals with significant sun exposure.
- Facial skin resurfacing techniques are explored for both therapeutic and prophylactic benefits.
Purpose of the Study:
- To evaluate the efficacy of three facial skin resurfacing modalities in treating AKs.
- To assess the role of these treatments in preventing new primary basal and squamous cell carcinomas in high-risk individuals.
Main Methods:
- A randomized, prospective 5-year trial involving 34 patients with a history of facial AKs or NMSC.
- Interventions included 5% fluorouracil cream, 30% trichloroacetic acid peel, or carbon dioxide laser resurfacing.
- Outcomes measured included AK reduction at 3 months and NMSC incidence over 5 years.
Main Results:
- All three treatments (fluorouracil, trichloroacetic acid, CO2 laser) achieved significant AK reduction (83%-92%, P ≤ .03).
- Treated groups showed a significantly lower incidence of NMSC compared to the control group (P < .001).
- A trend towards a longer time to new skin cancer development was observed in treated patients (P = .07).
Conclusions:
- Facial skin resurfacing modalities effectively reduce AKs and offer prophylaxis against NMSC.
- Fluorouracil, trichloroacetic acid, and CO2 laser demonstrated comparable benefits in this study.
- Further investigation in larger trials is warranted to confirm these findings.
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