Laser-based therapies in the management of non-melanoma skin cancers: a narrative review

The rising global incidence of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) necessitates the exploration of tissue-sparing alternatives to surgical excision, which remains the gold standard. Laser systems (CO₂, Nd: YAG, PDL) offer a less invasive approach using selective photothermolysis, addressing functional and aesthetic concerns in anatomically sensitive areas. This narrative review summarizes the current clinical data on laser-based strategies for non-melanoma skin cancers (NMSC), focusing on treatment parameters, patient/lesion selection, oncologic outcomes (clearance and recurrence), and safety. A targeted search of PubMed, Embase, and Scopus up to May 2026 was synthesized narratively. For low-risk BCC, Nd: YAG lasers showed a 3.1% recurrence rate (7.9-year follow-up), while CO₂ lasers reported 9.4% (2.1-year follow-up). Pulsed dye laser (PDL) monotherapy was less reliable, with 38% recurrence. Evidence for cSCC remains limited, focusing on in situ disease and combined regimens. Integrating Reflectance Confocal Microscopy (RCM) and Laser-Assisted Drug Delivery (LADD) significantly improves oncologic efficacy and treatment depth. Laser therapy, particularly Nd: YAG and CO₂ systems, represents a viable tissue-sparing option primarily for low-risk BCC. However, evidence for cSCC remains limited and suggests higher recurrence rates, necessitating cautious patient selection.