Using cosmetic lasers to treat skin cancer

Summer is almost over, so we need to soak up every moment of air-dried waves, sweaty runs outdoors, and smock dresses. In the process of crossing off your summer bucket list, could you tell me when you last had your skin checked?

Over 9500 people are estimated to be diagnosed with skin cancer every day (though the amount could actually be higher due to delays caused by the pandemic). OptiSkin Medical dermatologist Orit Markowitz MD notes that even though many of these cases are highly treatable non-melanoma basal and squamous cell carcinomas, the experience still takes a physical and emotional toll.

Dermatologists usually perform a biopsy on anything suspicious they find while examining your skin. You might receive the results over the phone the following week after you get the cut, Dr. Markowtiz says. “Obviously, removing it requires another appointment if it requires treatment.”

A method developed by Dr. Markowitz can diagnose, measure, and treat many skin cancers in one appointment.

By using Reflectance Confocal Microscopy, or RCM, she performs a virtual biopsy instead of a surgical one. Photographs of the skin are taken at 30 times magnification using optical imaging. She notes that by doing so, a diagnosis is immediate.

When a nonmelanoma lesion proves to be cancerous, Mohs Surgery is the gold standard. (The Skin Cancer Foundation declares that it has a 99 percent cure rate). It was originally developed by Frederick Mohs in Wisconsin’s zoology lab, where he worked as a student when he was just 18 years old. It involves surgically removing and inspecting skin layers layer by layer. By removing only the cancerous cells, it allows surgeons to leave the healthy ones intact.

Are there any downsides? It’s surgery, says Dr. Markowitz — something most people would choose not to do if the option were available. Occasionally, scarring or holes in the skin need to be repaired after the process. As a means of avoiding surgery-or optimizing it-Dr. Optical Coherence Tomography is another advanced technique used by Markowitz.

Using broadband infrared light, OCT provides a blueprint of where and how much must be removed from a tumor (similar to an ultrasound). Among other journals, research shows that using OCT can accurately measure a tumor’s margin, reducing the need for unnecessary cutting prior to surgery.

If necessary, Dr. Markowitz often utilizes nonablative laser therapy to attempt to remove the cancer, employing devices such as pulse dye lasers and thermal resurfacing lasers that are typically used to minimize wrinkles. The study, led by Dr. Markowitz, was published in Cutis in March of 2012 and found that, in comparison to surgery, nonablative laser treatment resulted in better cosmetic outcomes, as well as less downtime and reconstruction after surgery. Several of my patients have full-blown basal cells that extend below their eyes to their cheeks,” explains Markowitz. “As we were treating her basal cell, her dark circles under that eye disappeared almost completely.”

Among dermatology offices, RCM and OCT are mostly found in universities, not in offices of dermatologists. Earlier this year, Dermatologic Clinics surveyed dermatologists to find out how much they incorporate new technologies like these into their routine skin checks. Currently, OCT isn’t covered by insurance because OCT is still considered an investigational procedure in the U.S., which means they can be more costly for dermatologists and patients.

Dr. Markowitz hopes that will change with continued research, however. Her approach was described in Cutis in a small study where 100 percent of basal cell carcinomas were cleared–82 percent in the same appointment as diagnosis. As Markowitz recalls, he began the protocol back in 2008 as a potential alternative to Mohs surgery. Mohs surgery now seems like the best alternative to me.”

One of the best ways to prevent skin cancer? Wear sunscreen:

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