The Combination of Fractionated Erbium:yag Laser Skin Microporation and Topical Imiquimod Is A New, Safe and Efficient Strategy For the Treatment of Actinic Keratosis and Basal Cell Carcinoma: Report of Two Pilot Studies - The Combination of Fractionated Erbium:yag Laser Skin Microporation and Topical Imiquimod Is A New, Safe and Efficient Strategy For the Treatment of Actinic Keratosis and Basal Cell Carcinoma: Report of Two Pilot Studies - Open Access Pub

DOI10.14302/issn.2471-2175.jdrt-14-552 Basal cell carcinoma (BCC) is among the most common cancers in Europe, North America and Australia with an estimated 2.8 million cases in the US each year 1, 2. According to the European Skin Cancer Foundation the incidence for BBC in Europe is about 50 to 80 new patients per 100.00 persons per year and in Australia about 250 per 100.00 persons per year 3. The gold standard of treatment for BCC is Mohs micrographic surgery 4. However, surgery is not always possible due to large tumours, problematic locations (e.g. the face), multimorbid patients or the decision of the patient. For this patient cohort multiple different topical therapies such as the photodynamic therapy (PDT) have been established 5. With regard to topical 5% Imiquimod (IQM, Aldara？, Meda Pharma S.A./N.V., Brussels, Belgium) the approved dosage for superficial BCC is 5x/week for altogether 6 weeks. In Europe, 34% of men and 18% of women older than 70 years of age develop actinic keratosis (AK), also known as solar keratosis or keratinocytic intra-epidermal neoplasia 6. Although the probability that AK transforms into squamous cell carcinoma is quite low, the course is unpredictable which makes the therapy of AK a necessity. While single lesions are usually treated with cryosurgery, multiple lesions associated with the phenomenon of field cancerisation are asking for a more widespread topical approach 7. The IQM regimen is defined as applications 3x/week for 4 weeks followed by a 4 week therapy free interval. Eight weeks after initiation of the therapy, the physician is asked to decide on the necessity of a second 3x/week 4 week treatment course 8, 9, 10, 11. IQM acts as a Toll-like receptor agonist (TLR-7 and TLR-8), thus inducing the production of pro-inflammatory cytokines and subsequent cytotoxic T-cell mediated cell death, but also TLR-independent pathways for apoptosis and inflammation have been reported 12. On clinical grounds, the IQM–related therapeutic effects individually differ in their strength by forming just skin erythema and crusting up to erosions and ulcerations. An essential weakness of the IQM therapy in BCC and AK is the danger of inadequate or missed application by the patient and long therapy periods aggravated by the burden of the IQM induced skin reactions. The P.L.E.A.S.E. laser system (Pantec Biosolutions, Ruggell, Liechtenstein) is a fractionated erbium: YAG laser with the potency to set per shot one field of up to several hundred micropores into the epidermis down to the dermo-epidermal junction 13. The novel diode pumped