By Kathleen Berger, Executive Producer for Science and Technology
Basia Marie Michalski, MD, FAAD recommends a nonablative fractional laser treatment for a few cosmetic concerns patients want to address.
“To treat brown spots on the skin, for facial rejuvenation, it decreases pore size,” said Michalski, assistant professor of dermatology at Washington University School of Medicine and dermatologist for Washington University Physicians and Siteman Cancer Center. “Fraxel laser is a nonablative fractionated laser, which means that it’s not breaking the top layer of skin. It’s delivering all of its energy into the dermis, which is that second layer of skin right under our epidermis.”
The nonablative fractional laser is often used for anti-aging or facial rejuvenation as a skin resurfacing treatment. The procedure is performed by dermatologists or offered at the plastic surgeon’s office.
“It’s called the Fraxel Dual. So, the Fraxel Dual is the name of the laser and the ‘dual’ refers to the two wavelengths of the Fraxel. There’s a 1550 nanometer, which goes a little bit deeper, delivering energy into the deep dermis of the skin. And so, it’s targeting those deeper acne scars or those deeper lines and wrinkles to improve the texture of the skin,” she explained. “The 1927 nanometer lasers, that’s a thulium laser, and it’s targeting water. The idea is that it helps kind of pull those brown spots off the skin.”
Michalski says the laser treatment may have added benefits.
“Already studied for treatment of precancers, and so it does treat precancers,” she said. “The next step was a study out of Massachusetts General Hospital. It was published in 2023, so just a few months ago, by one of our laser experts in the country.”
The small study by a team of researchers at Massachusetts General Hospital suggests the laser treatment may help to prevent the development of common types of nonmelanoma skin cancer.
“I do tell patients about the study because I think it’s interesting,” said Michalski.
The study reviewed the records of 43 skin cancer patients who received the laser therapy and 52 skin cancer patients who did not have the laser treatment. All of the skin cancer patients typically have a 35% risk of developing new cancer within three years and a 50% risk of recurrence within five years.
“Patients who did not have the laser treatment had a 2.65 increased risk, that’s over two-fold or two times increased risk of skin cancer compared to the patients who did have the laser treatment,” she said. “The study that was recently published showed that the Fraxel Dual treatment can both reduce the risk of precancer, so actinic keratosis and it can also reduce the risk of nonmelanoma skin cancers.”
“Why does it reduce your risk of skin cancer? It’s possible that it decreases the mutational burden of our skin so if we’re actually removing small fractions of the skin, maybe we’re reducing the overall mutations on the skin surface from photodamage or from sun.”
If future studies with the laser treatment show continued success preventing skin cancer, Michalski wants to know the specific procedural guidelines for effectiveness.
“I would be curious to know what laser setting do we need to use that truly reduces that risk of skin cancer? Because there are two different wavelengths that kind of combined everything in the study, but it’s a really important first step.”
For now, Michalski says telling her patients about the possibility of cancer prevention helps them feel better about choosing the cosmetic procedure.
“It is exciting and it’s something that I do mention to patients as an added benefit. I wouldn’t necessarily market it as a treatment for skin cancer at this point.”
