Skin Resurfacing for Skin Cancer Prevention

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Skin Resurfacing for Skin Cancer Prevention

Three resurfacing modalities were equally effective, so the difference may come down to cost.

Several skin resurfacing methods have been reported to reduce the incidence of new nonmelanoma skin cancers (NMSCs) and actinic keratoses (AKs). Which is the most effective? In this 5-year trial, 34 patients with a history of facial AKs, scalp AKs, or NMSCs were randomized to treatment with one of three modalities. The investigators compared two passes with a carbon dioxide laser, a chemical peel with 30% trichloroacetic acid (TCA), or 3 weeks of twice-daily applications of 5% fluorouracil cream. Seven patients did not initiate any treatment; 5 of these served as controls. All patients were instructed to use an SPF 30 sunscreen and a 0.05% tretinoin cream daily after treatment.

All three modalities produced similar reductions in AKs at the 3-month follow-up (by 83%–92%). After a minimum of 2 years of follow-up, the per-patient-year incidence of new NMSCs in all three treatment groups (0.04, 0.15, and 0.21 for TCA peel, 5-fluororacil, and laser, respectively) was significantly lower than in the control group (1.57 per patient year). There were no statistically significant differences between treatment groups in NMSC incidence. There was a trend toward a longer time to the development of new NMSCs in the treatment groups compared with the control group. Only 50% of patients adhered to the sunscreen and retinoid treatment regimen. Patients who underwent the TCA peel reported less pain and faster healing than patients who were treated with 5-fluorouracil or laser resurfacing.

Comment: The efficacy of carbon dioxide laser resurfacing and TCA chemical peel seems to be similar to the efficacy of topical 5-fluorouracil treatment for treating AKs and preventing NMSCs. Without a clear advantage for any one of the three modalities, the cost effectiveness of 5-fluorouracil cream suggests that it should remain the primary option for treating diffuse AKs.

— George J. Hruza, MD

Published in Journal Watch Dermatology August 25, 2006