Vol.:(0123456789) American Journal of Clinical Dermatology https://doi.org/10.1007/s40257-020-00562-8 SYSTEMATIC REVIEW Laser Treatment for Non‑Melanoma Skin Cancer: A Systematic Review and Meta‑Analysis Eran Sharon 1,3  · Igor Snast 2,3  · Moshe Lapidoth 2,3  · Ran Kaftory 3  · Daniel Mimouni 2,3  · Emmilia Hodak 2,3  · Assi Levi 2,3 © Springer Nature Switzerland AG 2020 Abstract Background Surgery is the mainstay of treatment for non-melanoma skin cancer. Lasers are an additional option. Objective The objective of this study was to review the literature on the efcacy and safety of lasers for the treatment of non-melanoma skin cancer. Methods A systematic review and meta-analysis of laser treatment for non-melanoma skin cancer was performed. The primary outcome was recurrence rate (RR). Results The review included 32 studies (six randomized controlled trials and 26 cohort studies): 27 evaluated basal cell carcinomas (BCCs), three squamous cell carcinomas, and two both, for a total of 4755 BCCs and 214 squamous cell carci- noas. Most BCCs were low risk. The Nd:YAG laser (seven studies, 3286 BCCs) had a 3.1% RR (95% confdence interval [CI] 1.4–6.4%) during a mean follow-up of 7.9 years, with a low rate (< 20%) of scarring and dyspigmentation. The CO 2 laser (ten studies, 904 BCCs) had a 9.4% RR (95% CI 4.1–20) during a mean follow-up of 2.1 years, with a low rate of side efects. The pulsed dye laser (eight studies, 206 BCCs) had a 38% RR (95% CI 24–55). In two studies, the Nd:YAG laser demonstrated a RR of 10% (95% CI 2–31) for Bowen’s disease, and in three studies, the CO 2 laser demonstrated a RR of 22% (95% CI 5–61) for squamous cell carcinoma. Conclusions Based on cohort studies, the Nd:YAG laser is a safe and efcacious modality for the treatment of low-risk BCC. Based on settings applied in prior studies in the literature, the CO 2 laser is less efcacious than the Nd:YAG laser, thus it cannot be recommended for BCC treatment. Insufcient data preclude conclusions regarding laser treatment for squamous cell carcinoma. Registration PROSPERO registration number CRD42019129717. Eran Sharon and Igor Snast contributed equally to the manuscript. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40257-020-00562-8) contains supplementary material, which is available to authorized users. * Igor Snast snastigor@gmail.com 1 Department of Surgery, Breast Surgery Clinic, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel 2 Laser Unit, Division of Dermatology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva 4941492, Israel 3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 1 Introduction Non-melanoma skin cancer (NMSC) is the most common type of malignancy worldwide [1]. Basal cell carcinoma (BCC) accounts for approximately 80% of all NMSCs, and squamous cell carcinoma (SCC) for approximately 20%. Other tumors comprise less than 1% of NMSC cases. The global incidence of NMSC has been gradually increasing since the 1960s. Given that more than 80% of NMSCs occur in people aged 60 years and older, this trend is expected to continue with the growth of the aging population and the steady rise in life expectancy [2]. Surgery, including Mohs micrographic surgery, is con- sidered the gold standard of treatment for most NMSCs. However, other modalities are also available, including radi- otherapy, photodynamic therapy, cryosurgery, and topical applications such as imiquimod [3]. In recent years, hedge- hog pathway inhibitors (vismodegib, sonidegib) have been incorporated into clinical practice [4, 5]. All these modali- ties have variable clearance rates, and they are associated with a risk of scarring and functional defects or systemic side efects. Cost, convenience, and cosmetic results are