Reflectance confocal microscopy-guided carbon dioxide laser ablation of low-risk basal cell carcinomas: A prospective study

J Am Acad Dermatol. 2019 Oct;81(4):984-988. doi: 10.1016/j.jaad.2019.06.014. Epub 2019 Jun 14.


Background: Basal cell carcinoma (BCC) treatment modalities can be stratified by tumor subtype and recurrence risk. The main limitation of nonsurgical treatment modalities is the lack of histopathologic confirmation. Reflectance confocal microscopy (RCM) is a noninvasive imaging device that provides quasihistologic images.

Objective: To evaluate the feasibility and efficacy of RCM-guided carbon dioxide (CO2) laser ablation of low-risk BCCs.

Methods: Prospective study with biopsy specimen-proven low-risk BCCs imaged with RCM. RCM was performed on these sites before and after ablation. If residual tumor was found, a new series of laser passes were performed. The patients were then monitored for recurrence clinically and with RCM.

Results: Twenty-two tumor sites in 9 patients (5 men, 4 women) were imaged and treated. Median age was 59 ± 12.9 years (range, 30-74 years). Mean tumor size was 7.7 mm (range, 5-10 mm). Residual tumor was identified in 5 of 22 cases (22.7%) under RCM on immediate first-pass postablation sites, prompting additional laser passes. Median follow-up was 28.5 months (range, 22-32 months) with no recurrences found.

Conclusions: Addition of RCM to laser ablation workflow can detect subclinical persistent tumor after initial ablation and may serve as an aid to increase the efficacy of laser ablation.

Keywords: ablation; basal cell carcinoma; carbon dioxide laser; diagnosis; follow-up; laser; reflectance confocal microscopy; treatment.

MeSH terms

  • Adult
  • Aged
  • Biopsy
  • Carcinoma, Basal Cell / diagnostic imaging
  • Carcinoma, Basal Cell / pathology
  • Carcinoma, Basal Cell / surgery*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Laser Therapy / instrumentation
  • Laser Therapy / methods*
  • Lasers, Gas / therapeutic use*
  • Male
  • Microscopy, Confocal
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / prevention & control
  • Neoplasm, Residual
  • Prospective Studies
  • Risk Assessment
  • Skin / diagnostic imaging
  • Skin / pathology
  • Skin / radiation effects
  • Skin Neoplasms / diagnostic imaging
  • Skin Neoplasms / pathology
  • Skin Neoplasms / surgery*
  • Treatment Outcome