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Fragile hands: targeting nonmelanoma skin cancer on older hands using 595 nm pulsed dye laser
Elliott D Herron1, Ashley M Snyder2,3,4, Christopher M Hull2
1Heersink School of Medicine, University of Alabama Birmingham, Birmingham, Alabama, United States.
Purpose:
The mainstay of treatment for nonmelanoma skin cancer (NMSC) on thin skin remains surgical, but procedures on older hands may be complicated by skin fragility and dermal atrophy. Used without cooling, 595 nm (nm) pulsed dye laser (PDL) has the capability of destroying NMSC through nonspecific thermal necrosis. The purpose of this study was to understand recurrence of NMSC on dorsal hands of older patients after one or two treatments using 595 nm PDL.
Methods:
A retrospective chart review identified 147 cases of NMSC located on the dorsal hands treated with 595 nm PDL. Cases of basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) were included. All patients received one to two treatments with PDL. The primary outcome was the recurrence of carcinoma.
Results:
Among NMSC cases treated with PDL, recurrence occurred in 12 patients (8.2%). No cases of BCC recurred during the study period. Recurrence of SCC was 4.7% for SCC in situ and 10.4% recurrence for invasive SCC (p = 0.34). Among 71 patients treated once, recurrence occurred in 10 patients (14.1%), and among 76 cases treated twice, recurrence occurred in 2 patients (2.6%, p = 0.01).
Conclusion:
Two treatments of PDL for NMSC on the dorsal hands of older patients was well tolerated, had low recurrence, and seemed more effective than one treatment.
Insights
Two treatments of 595 nm pulsed dye laser (PDL) for nonmelanoma skin cancer (NMSC) on older hands showed low recurrence rates. This laser therapy is well-tolerated and more effective than a single treatment for NMSC on the dorsal hands.
Area of Science:
- Dermatology
- Oncology
- Laser Medicine
Background:
- Nonmelanoma skin cancer (NMSC) treatment on older adults' hands is challenging due to skin fragility.
- Surgical options for NMSC on thin skin can be complicated in elderly patients.
- 595 nm pulsed dye laser (PDL) offers a non-surgical approach for NMSC via thermal necrosis.
Purpose of the Study:
- To evaluate NMSC recurrence on older patients' dorsal hands after one or two 595 nm PDL treatments.
- To assess the efficacy and safety of PDL for treating NMSC in a fragile skin environment.
Main Methods:
- Retrospective chart review of 147 NMSC cases on dorsal hands treated with 595 nm PDL.
- Inclusion of basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs).
- Analysis of recurrence rates based on one versus two PDL treatment sessions.
Main Results:
- Overall NMSC recurrence rate was 8.2% (12/147 patients).
- No BCC recurrences were observed; SCC recurrence was 4.7% for in situ and 10.4% for invasive.
- Recurrence was significantly lower after two treatments (2.6%) compared to one treatment (14.1%, p=0.01).
Conclusions:
- Two 595 nm PDL treatments are well-tolerated for NMSC on older patients' dorsal hands.
- Dual PDL treatment demonstrates superior efficacy with lower recurrence rates compared to a single session.
- 595 nm PDL presents a promising, effective, and safe therapeutic option for NMSC in this patient population.
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