Dermatologic Lasers in the Management of Keratinocyte Carcinoma: Lesion-Directed Treatment and Field-Directed Secondary Prevention

Keratinocyte carcinoma (KC) is the most common malignancy worldwide, and its incidence continues to rise. In addition to direct DNA damage, ultraviolet radiation promotes immunosuppression and field cancerisation, thereby contributing to the development of actinic keratoses (AKs) and KC. Against this background, dermatologic lasers have been investigated both for the lesion-directed treatment of selected tumours and for field-directed interventions aimed at reducing the risk of new lesions in chronically photodamaged skin. This narrative review examines the evidence on lasers in KC management, summarising each study by design, numbers of patients and lesions, parameters, outcomes, follow-up and level of evidence. Pulsed dye laser and long-pulsed 1064 nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, which differ in mechanism, penetration depth and evidence base, as well as ablative lasers, may be useful in selected low-risk basal cell carcinomas, whereas non-ablative fractional lasers mainly reduce AK burden. Among field-directed approaches, fractional ablative resurfacing shows the strongest evidence for reducing both AK and subsequent KC. However, the evidence remains limited by small studies, heterogeneous protocols, short follow-up, lesion-level analyses and frequent lack of systematic histological confirmation.