Facial Resurfacing Treatments for Photoaging May Also Help Prevent Skin Cancer

If you think facial resurfacing procedures are just cosmetic, think again.

Facial resurfacing techniques - medical treatments that improve the look and feel of skin - are popular with patients looking to treat signs of photoaging (premature aging caused by ultraviolet exposure) like wrinkles, fine lines, leatheriness, discoloration, and sagging skin. But research now shows that chemical and laser peels (as well as other techniques) similar to the ones dermatologists use to restore skin's youthful appearance may help prevent skin cancer, too.

In a recent study conducted at the Veterans Affairs Palo Alto Medical Center in California, facial resurfacing methods including carbon dioxide (CO2) laser resurfacing and trichloroacetic acid (TCA) peels successfully treated actinic keratosis (AK), the most common skin precancer. These scaly or crusty growths often appear on areas of the body frequently exposed to the sun, such as the face, ears, lips, bald scalp, backs of the hands and forearms, shoulders and neck. Up to 10 percent of actinic keratoses develop into squamous cell carcinoma (SCC), the second most common skin cancer; in fact, many dermatologists believe that actinic keratoses are actually an early stage of squamous cell carcinoma. Since 40-60 percent of all squamous cell carcinomas start as actinic keratoses, the success of these facial resurfacing techniques in treating actinic keratoses suggests that the procedures can help prevent many skin cancers.

Treatments Compared

Liquid nitrogen, or LN2 cryotherapy, a destructive method which freezes lesions and causes them to fall off, is the most common AK treatment. But in the VA study, Susan M. Swetter, MD, and colleagues treated 24 patients with either a 30 percent TCA chemical peel, a 5 percent fluorouracil (5-FU) cream (a topical medication) applied twice a day for three weeks, or a CO2 laser peel to assess both reductions in development of actinic keratoses and prevention of nonmelanoma skin cancers. All participants had histories of facial or scalp actinic keratoses and/or basal or squamous cell carcinoma (BCC or SCC).

Following treatment, all subjects were examined every three months for two years, and all procedures proved to reduce incidence of actinic keratoses effectively at the first three-month evaluation post-treatment. With 5-FU, the number decreased from almost 62 before treatment to less than 9 (83 percent reduction) three months after treatment; with TCA, the number was reduced from over 83 to less than 8 (89 percent); with the laser, from 78 to 5.5 (92 percent reduction). And all three methods reduced basal cell carcinomas and squamous cell carcinomas significantly (TCA by 40 percent) in up to 4.5 years of long-term follow-up, compared to the number found in a sampling of patients (control group) who were not treated.

While the three treatments performed comparably, one method was most popular with patients. "From a subjective standpoint," notes Dr. Swetter, "the TCA arm was tolerated more favorably, with rapid time to healing and less discomfort than the 5-FU and CO2 laser arms."

The study was small, so "larger samples are definitely needed to confirm our findings," Dr. Swetter explains. But the outcome was nonetheless extremely promising, not only for expanding the arsenal of actinic keratosis treatments, but in offering another tool for skin cancer prevention.