Pulsed Dye Laser (PDL) in the Treatment of Basal Cell Carcinoma: A review.

Surgery remains the primary treatment for non-melanoma skin cancer including basal cell carcinoma, though laser therapy has emerged as an alternative or adjunctive option. This review aims to evaluate the available literature on the use of pulsed dye laser (PDL), for the treatment of basal cell carcinoma, focusing on complete response, patients’ satisfaction, side effects, study designs, treatment parameters, recurrence rates, and side effects. This review was conducted to evaluate the use of pulsed dye laser (PDL) therapy in the treatment of basal cell carcinoma (BCC). A comprehensive literature search was performed across PubMed, Cochrane Library, MEDLINE, Embase, covering studies published from the 1960s through August 2025. Search terms included “basal cell carcinoma,” “pulsed dye laser,” and “laser therapy,”. Eligible studies included prospective and retrospective clinical trials, randomized controlled trials, case series, and case reports involving histologically confirmed BCCs treated with PDL alone. Studies combining laser therapy with other treatments or involving non-BCC skin cancers were excluded. Data were extracted on study design, patient demographics, tumor characteristics, laser parameters, clinical outcomes, recurrence, adverse effects, and cosmetic results. Due to methodological and reporting heterogeneity, a narrative synthesis was performed rather than a meta-analysis. A total of 14 studies evaluated the use of pulsed dye laser (PDL) therapy for the treatment of 267 basal cell carcinomas (BCCs) between 2003 and 2023. The studies represented a range of methodologies, including pilot studies, case series, randomized controlled trials, retrospective reviews, and individual case reports. The majority employed the 595 nm wavelength, while earlier studies investigated 585 nm devices. Four studies focused exclusively on superficial BCCs (sBCCs) and reported clearance rates ranging from 16 to 79%, with greater success associated with multiple treatment sessions. Two studies included nodular, infiltrative, or mixed subtypes, which demonstrated lower response rates, particularly in tumors exceeding 1.5 cm in diameter. One study evaluated single-pass versus stacked-pulse regimens, showing improved outcomes with stacked pulses, particularly in superficial tumors. Across the reviewed studies, treatment protocols most commonly involved 3 to 5 sessions at 2- to 4-week intervals. Repeated sessions generally resulted in higher clearance rates, while single-session approaches produced partial or variable responses. Use of the 595 nm PDL appeared more effective than 585 nm, likely due to its greater dermal penetration and more precise targeting of tumor vasculature. Overall clearance rates across all BCC subtypes ranged from 25 to 92%, depending on factors such as tumor size, histological subtype, treatment regimen, and duration of follow-up. Tumors less than 1.5 cm in diameter showed the highest rates of complete response, whereas larger or multifocal lesions were more resistant and had increased recurrence risk. Recurrences were documented in several studies, typically occurring within 6 to 17 months after treatment, highlighting the need for ongoing clinical surveillance. Reported adverse effects were generally mild and self-limiting, including purpura, erythema, edema, crusting, and pigmentary changes. Importantly, cosmetic outcomes were consistently favorable, with minimal scarring and high levels of patient satisfaction. Pulsed dye laser (PDL) therapy has gained attention as a minimally invasive alternative for basal cell carcinoma (BCC) management. Evidence suggests that PDL can achieve favorable outcomes in superficial and small lesions, particularly with multiple treatment sessions and optimized parameters. However, clearance rates remain inconsistent and generally lower than those achieved with standard therapies such as surgical excision, Mohs micrographic surgery, or topical modalities. At present, PDL may be best considered for low-risk, superficial BCCs in patients who have contraindications to conventional treatments or where cosmetic outcomes are a priority. Further large-scale studies with standardized protocols and long-term follow-up are required to clarify its role in routine clinical practice.