Optical coherence tomography-assisted 1064nm Nd:YAG laser therapy of superficial and nodular basal cell carcinomas with ≤1mm tumor thickness

Abstract

<strong>BACKGROUND:</strong> With an incidence of up to 250 new cases per 100000 inhabitants per year, basal cell carcinomas (BCC) represent the most common tumor entity in the western world. The treatment of so-called superficial BCC with a thickness of =1mm in accordance with clinical guidelines includes surgical removal and, alternatively, topical therapy using photodynamic therapy, local immunotherapy or chemotherapy. A new method for the treatment of superficial basal cell carcinomas is laser therapy with a long-pulsed 1064nm Nd:YAG laser. <br /> Optical coherence tomography (OCT) is an established diagnostic procedure for basal cell carcinomas that enables a horizontal delimitation of the tumor, an exact measurement of the penetration depth and analysis of the vascular plexus. <br /> <strong>OBJECTIVE:</strong> Our goal is to further evaluate 1064nm Nd:YAG laser therapy of BCC as a potential alternative treatment, employing D-OCT and histopathology to standardize effective treatment protocols. <br /> HYPOTHESIS: OCT-assisted Nd:YAG laser treatment of BCC is a safe and effective diagnostic and treatment method with comparable clearance rates to second-line therapies. Improved patient satisfaction, tolerability, practicability and cosmetic end result compared to surgery and second-line therapies are proposed. <br /> <strong>MATERIAL AND METHODS:</strong> In this retrospective cohort study, 50 histologically-confirmed superficial and nodular BCC with tumor thickness =1mm were treated with 1064nm Nd:YAG laser. Initial D-OCT scans were performed and repeated 3 months post-treatment. Tumoral clearance was histologically confirmed and local adverse effects, patient tolerability and satisfaction were recorded. Clinical remission was evaluated after one year. <br /> <strong>RESULTS: </strong> Complete clearance was achieved in 78% of BCC (39/50) at 3-month follow-up. Treatment failures were slightly more likely to correspond to superficial BCC (91%, 10/11) of thickness =0.5mm (73%, 8/11), located on the trunk (64%, 7/11). No treated lesions presented scarring. Patient satisfaction and tolerability displayed excellent results. Remission at one year occurred in 100% of initially cleared BCC (35/35, 4 patients were lost to follow-up due to non-medical reasons). <br /> <strong>CONCLUSION:</strong> OCT-assisted 1064nm Nd:YAG laser treatment of superficial BCC is a safe and effective method with excellent patient satisfaction, tolerability, practicability and cosmetic end result.