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

Summary

Across 12 studies (7,358 lesions), Nd:YAG laser was used predominantly for basal cell carcinoma with encouraging clearance and cosmetic outcomes in low-risk lesions; evidence for SCC and melanoma is limited and mostly in early/thin cases. Lack of margin control and heterogeneous methods constrain broad adoption, but the modality is a promising minimally invasive option for selected patients, particularly in cosmetically sensitive sites or non-surgical candidates.

Key Findings

• Twelve studies from 1985–2023 reported 7,358 histologically confirmed malignancies treated with Nd:YAG laser: 6,846 BCC (93.0%), 185 SCC (2.5%), 323 melanoma (4.4%), and 4 Bowen’s disease.
• Most favorable outcomes were in low-risk BCC with good cosmetic results and reduced morbidity vs surgery; SCC and melanoma treatments were limited to early/thin lesions with experimental status for melanoma.
• Major limitations include lack of margin control, heterogeneous protocols, and variable recurrence data, restricting generalizability and broad adoption.

Clinical Implications

Consider Nd:YAG laser for low-risk BCC (and possibly early SCC) in cosmetically sensitive locations or when surgery is contraindicated, with thorough counseling about lack of histologic margin control and the need for careful follow-up. Avoid routine use in melanoma outside research settings.

Limitations

• Heterogeneity of study designs and protocols; limited randomized data
• No histologic margin control with laser; inconsistent and incomplete long-term recurrence reporting

Future Directions

Prospective, standardized protocols with long-term oncologic outcomes (clearance, recurrence) and comparative effectiveness versus surgery or other modalities, including cost-effectiveness and patient-reported cosmetic outcomes.