Fractional Lasers and PDL May Reduce Future Keratinocyte Carcinoma Risk

Emerging evidence suggests that certain laser and resurfacing procedures may reduce the future risk of nonmelanoma skin cancerwhile simultaneously improving photodamaged skin, according to Elizabeth Tanzi, MD, during her session, “Update on the Use of Lasers to Reduce the Risk of Nonmelanoma Skin Cancer​,” presented at Music City SCALE 2026.

Dr Tanzi reviewed evolving data on nonablative fractional laser (NAFL), pulsed dye laser (PDL), and chemical peels as potential prophylactic interventions in patients with a history of keratinocyte carcinoma (KC).

Research from Jeffrey B. Travers, MD, and Dan Spandau, PhD, identified impaired insulin-like growth factor 1 (IGF-1) signaling in aging skin as a possible contributor to carcinogenesis. In healthy skin, “IGF-1 from dermal fibroblasts activates the IGF-1 receptor in the epidermis to initiate several abortive mechanisms when faced with UVB-induced DNA damage.” Aging fibroblasts produce less IGF-1, potentially weakening this protective response.

Dr Tanzi presented clinical studies suggesting that resurfacing procedures may partially restore these physiologic mechanisms. A retrospective cohort study evaluating NAFL treatment in patients with prior facial KC found significantly lower rates of subsequent KC development compared with matched controls. Facial KC developed in 20.9% of NAFL-treated patients vs 40.4% of controls. The investigators concluded that “NAFL treatment was associated with a decreased risk of subsequent facial KC development and may have a benefit for KC prophylaxis.”

Additional work examined histologic changes following 25% trichloroacetic acid (TCA) peels and NAFL treatment. Both TCA and 1550-nm NAFL produced elongated fibroblast morphology consistent with younger fibroblasts, suggesting partial reversal of senescence-associated changes.

PDL was also associated with reduced KC risk. In a retrospective cohort analysis, subsequent facial KC developed in 27.1% of PDL-treated patients compared with 54.2% of controls. Proposed mechanisms included reduction of carcinogenic inflammation, vascular targeting of incipient tumors, and enhanced immune surveillance.

Further evidence supporting field therapy approaches comes from a study evaluating 1927-nm thulium fractional laser treatment for actinic keratosis (AK). Patients experienced significant reductions in AK counts alongside increased dermal thickness and fibroplasia. The treatment was described as “safe and well-tolerated” for field cancerization management.

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Reference
Tanzi E. Update on the use of lasers to reduce the risk of nonmelanoma skin cancer. Presented at: Music City SCALE Symposium; May 13–17, 2026; Nashville, TN.