Nd: YAG laser in the treatment of non-melanoma and melanoma skin cancers.

Surgical excision remains the cornerstone treatment for skin cancer, considered the gold standard in clinical practice. However, alternative methods such as laser therapy are being explored for their potential to achieve tumor control while minimizing tissue damage and improving cosmetic outcomes. This review analyzes the existing literature on the use of Nd: YAG laser in the management of non-melanoma and melanoma skin cancer, with the aim of evaluating clearance and recurrence rates, as well as gaining deeper insights into the efficacy, safety, and potential side effects linked to this treatment approach. A systematic literature search was conducted using Embase, PubMed, Google Scholar, and Cochrane with the keywords: "Nd: YAG laser," "skin cancer," and "treatment." The search encompassed studies published from 1985 to July 2023 and included prospective, retrospective, double-blind randomized controlled trials, and non-blinded clinical trials in English. Studies were selected based on their focus on the use of Nd: YAG laser for non-melanoma including basal cell carcinoma and squamous cell carcinoma and melanoma skin cancer treatment, specifically excluding those that investigated the combination of ND: YAG laser with other therapies. Only studies reporting on the direct application of ND: YAG laser in treating various forms of skin cancer or premalignant skin lesions were considered for inclusion. Across all identified Nd: YAG laser studies from 1985 to 2023 (n = 12), a total of 7,358 histologically confirmed skin malignancies were reported, including 6,846 basal cell carcinomas (BCCs), 185 squamous cell carcinomas (SCCs), 323 malignant melanomas, and 4 cases of Bowen's disease. BCCs accounted for the vast majority of treated lesions (93.0%), followed by malignant melanoma (4.4%), SCC (2.5%), and Bowen's disease (0.05%). In calculating these totals, only lesions explicitly reported in each study were included. For instance, Brunner et al. (1985) described four patients with nevoid basal cell carcinoma syndrome as having "hundreds" of lesions; however, because the exact number was not provided, only the 200 histologically confirmed BCCs from this cohort were counted to avoid overestimation. No overlapping patients between studies were assumed unless explicitly noted. Moskalik et al. (2009) treated 188 recurrent limited BCCs alongside 3,346 primary BCCs, while Moskalik and Kozlow (2010) treated 172 recurrent limited BCCs within a cohort of 2,837 patients. El Tonsy et al. (2004) included patients with previously treated lesions, emphasizing the clearance of 37 BCCs, some of which were recurrent. Sharmazan et al. (1996) and later studies (Ortiz 2015/2018; Ahluwalia 2019; Markowitz & Bressler 2021; Kranz 2023) mostly treated primary BCCs but some non-facial and challenging anatomical locations likely included previously treated lesions. SCCs and melanomas were treated less frequently, usually in early-stage or thin lesions, and Bowen's disease appeared rarely. Taken together, these results indicate that Nd:YAG laser therapy has been applied predominantly to BCCs, reflecting both the high prevalence of this tumor type and the favorable safety and cosmetic outcomes reported. SCCs and melanomas were treated less frequently but showed encouraging clearance and cosmetic results in early-stage or low-thickness lesions, while Bowen's disease appeared only rarely in the literature. Nd:YAG laser therapy represents a promising, minimally invasive option for selected cases of non-melanoma skin cancers, offering good cosmetic outcomes and reduced morbidity compared to surgery. Its effectiveness in low-risk BCC and SCC, especially in cosmetically sensitive areas or for non-surgical candidates, is supported by current evidence. However, limitations such as lack of margin control and variable results restrict broader use, and its application in melanoma remains experimental. Continued research through standardized, long-term studies is needed to confirm its oncologic safety and define its future role in dermatologic oncology.