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Combining Lasers and Chemotherapeutics for Non-Surgical Skin Cancer Treatment
Abstract   Peer reviewed

Combining Lasers and Chemotherapeutics for Non-Surgical Skin Cancer Treatment

Anna Delay, Alina Bridges, Kelly Frasier, Alex Silberzweig and Alexander T Velaoras
Lasers in surgery and medicine, v 58(S38), pp S30-S30
30 Jul 2026
DOI: https://doi.org/10.1002/lsm.70159#page=S30

Abstract

Chemotherapy Lasers and Masers Skin Cancer
Background: Traditional management of superficial cutaneous malignancies, including superficial basal cell carcinoma, squamous cell carcinoma in situ (Bowen disease), and extensive field cancerization with actinic keratoses, continues to rely on surgical excision and Mohs micrographic surgery due to superior clearance rates and precise histologic margin control. However, a considerable portion of patients are suboptimal surgical candidates because of anticoagulation therapy, immunosuppressive states, advanced age, cardiovascular comorbidities, or lesion location in anatomically or cosmetically sensitive regions such as the periocular skin, nasal ala, vermilion border, or conchal bowl. Patient preference also plays a growing role, with increasing demand for non‐invasive treatments that limit scarring, downtime, and functional disruption. Fractional laser‐assisted drug delivery (LADD) has developed as a precision‐based alternative capable of enhancing transcutaneous penetration and bioavailability of topical chemotherapeutic agents such as 5‐fluorouracil, imiquimod, diclofenac, and photosensitizers used in photodynamic therapy. Controlled ablative microchannels created by fractional laser platforms allow more uniform intradermal deposition of active agents, potentially improving therapeutic response, reducing treatment duration, and expanding organ‐preserving oncologic management options for select superficial skin cancers and premalignant lesions. Study Design/Materials and Method: A structured literature search was performed across PubMed, Scopus, and Google Scholar for studies published between January 2010 and January 2025. Search terms included controlled vocabulary and keyword combinations such as “fractional laser‐assisted drug delivery,” “ablative fractional resurfacing,” “topical chemotherapeutics,” “laser‐enhanced penetration,” “field cancerization,” and “superficial non‐melanoma skin cancer” (including superficial basal cell carcinoma, squamous cell carcinoma in situ, and extensive actinic keratoses). Inclusion criteria prioritized clinical studies, in‐vivo modeling, translational research on drug penetration kinetics, and trials evaluating therapeutic outcomes using imiquimod, 5‐fluorouracil, diclofenac, photodynamic therapy, or novel topical agents delivered following fractional laser application. Non‐English publications, animal‐only studies lacking translational relevance, and duplicated datasets were excluded. Results: Ablative fractional laser (AFL) has been shown to create microchannels that enhance intradermal delivery of 5‐FU and other chemotherapeutic agents. In a murine squamous cell carcinoma model, AFL and imiquimod in combination produced the most robust immune response and highest degree of tumor clearance compared with AFL or imiquimod alone. Clinically, AFL as a pretreatment has been shown to improve uptake and efficacy of topical 5‐FU in superficial basal cell carcinoma and squamous cell carcinoma in situ, resulting in a 71% clearance of superficial BCC (sBCC) and 100% clearance of SCCis at 4‐8 weeks. In a follow up study, 20 patients underwent shave biopsy to confirm clearance which remained high with 92% for SCCis and 67% for sBCC. In addition to its therapeutic efficacy, LADD may help prevent scarring by offering a nonsurgical alternative and, in itself, serving as an effective treatment for scars. Conclusion: Early clinical evidence demonstrates that fractional laser‐assisted delivery can significantly enhance the therapeutic performance of topical agents used for non‐surgical management of superficial non‐melanoma skin cancers and field cancerization. Improved penetration, higher local drug bioavailability, and more consistent treatment response suggest meaningful potential for LADD as an organ‐sparing, cosmetically favorable alternative for appropriately selected patients.

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