Laser Treatment for Non-Melanoma Skin Cancer: A Systematic Review and Meta-Analysis
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SYSTEMATIC REVIEW
Laser Treatment for Non‑Melanoma Skin Cancer: A Systematic Review and Meta‑Analysis Eran Sharon1,3 · Igor Snast2,3 · Moshe Lapidoth2,3 · Ran Kaftory3 · Daniel Mimouni2,3 · Emmilia Hodak2,3 · Assi Levi2,3
© Springer Nature Switzerland AG 2020
Abstract Background Surgery is the mainstay of treatment for non-melanoma skin cancer. Lasers are an additional option. Objective The objective of this study was to review the literature on the efficacy and safety of lasers for the treatment of non-melanoma skin cancer. Methods A systematic review and meta-analysis of laser treatment for non-melanoma skin cancer was performed. The primary outcome was recurrence rate (RR). Results The review included 32 studies (six randomized controlled trials and 26 cohort studies): 27 evaluated basal cell carcinomas (BCCs), three squamous cell carcinomas, and two both, for a total of 4755 BCCs and 214 squamous cell carcinoas. Most BCCs were low risk. The Nd:YAG laser (seven studies, 3286 BCCs) had a 3.1% RR (95% confidence interval [CI] 1.4–6.4%) during a mean follow-up of 7.9 years, with a low rate ( 50% indicating substantial heterogeneity. Substantial heterogeneity among studies was explored by meta-regression and subgroup analyses for the following variables: (1) predominant location of lesions (low vs moderate vs high risk); (2) predominant type of lesions (superficial vs nodular); (3) number of repeated treatments; and (4) type of study (cohort vs RCT). Sensitivity analysis was performed for studies with a mean follow-up of 1 year or longer. Publication bias was not assessed because of the small number of studies per laser type.
3 Results Our search yielded 3857 records. After the exclusion process, 32 studies were eligible for review [6, 7, 13–42] (Fig. 1). They included six RCTs and 26 cohort studies, with a total of 3894 patients with 4755 BCCs and 192 patients with 214 SCCs. Laser treatment of BCC was evaluated in 27 studies, of SCC in three studies, and of both BCC and SCC in two studies. The characteristics of studies that focused on the PDL, C O2 laser, and Nd:YAG laser are detailed in Table 1, and the characteristics of the studies that focused on other lasers are detailed in Tables S1–S2 of the ESM. All were published in peer-reviewed journals, except one (evaluating the multiplex 595/1064-nm laser for BCC treatment) that was extracted from the clinicaltrials.gov website and one (evaluating the PDL for BCC treatment) that was extracted from a conference abstract. The earliest study was published in 1974 by Wagner et al. [23] and investigated use of the C O2 laser for BCC treatment. The largest study was performed by Moskalik et al. [27] and investigated use of the Nd:YAG laser for BCC and SCC treatment in 2837 patients. The PDL, CO2 laser, and Nd:YAG laser were the most-evaluated modalities, in 8, 12, and 8 studies, respectively. The combination of the PDL and the Nd:YAG laser was evaluated in two studies, and the Er:YAG laser and combination of the PDL and the 1927-nm laser were each evaluated
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