Letter: The Superiority of Dermabrasion over Laser Abrasion in the Prophylaxis of Malignant and Premalignant Disease

Abstract

Letter to the Editor:Several of our Dutch colleagues ''cannot support'' 1 the conclusion of James Fulton and colleagues ''that laser resurfacing is not as effective as dermabrasion and deep chemical peel for the prophylaxis of basal cell carcinomas.'' 2 A remarkable stance, i.e, taking a position opposed to one of our time's great resurfacers, and a master of multiple techniques dedicated to that purpose. I have learned much from him myself, as have all physicians interested in a variety of resurfacing approaches.My personal experiences with dermabrasion over more than four decades, 3 my observations of laser patients' outcomes, my participation in a half-face study of dermabrasion versus CO 2 laser in Brazil, 4,5 and my survey of the statistics offered by the authors all reinforce my conclusion that Fulton and colleagues were indeed correct. Never, ever, did I see such recurrence rates as those seen in this laser study with my own dermabraded patients. I doubt any of the referenced and experienced physicians referenced in this article have either. I think the reasons are simple, the rules inviolate. It is long accepted that equal depth of injury allows equal results, ''the issue being one of degree rather than instrument, one of depth rather than treatment type.'' 6 However, visualization of a finite depth that is controllable by hand-eye coordination is a superior and safer end point than a setting on a machine or series of machines (regardless of machine types). Fresh wounds heal better than burned wounds, and the number of complications with laser resurfacing exceed those from manual dermabrasion (R. Geronemus, M. Goldman, W. Hanke, verbal communication ASDS, ca. 1996). Indeed, complications have critically and negatively impacted the numbers of laser resurfacings being performed in the United States, with infections, scars, prolonged healing, and recurrences all being more common with laser resurfacing.

Fractionated Laser Resurfacing Corrects the Inappropriate UVB Response in Geriatric Skin

“…Interestingly, there have been isolated reports and small studies which indicate that cosmetic wounding techniques, including FLR and dermabrasion, have been used to treat existing NMSC [Halachmi & Lapidoth, 2008; Choudhary et al, 2011]. In fact, dermabrasion has also been reported to successfully prevent the recurrence of actinic keratosis and NMSC [Field, 2007]; however, the extensive cutaneous damage inherent with dermabrasion therapy is often unacceptable [Field, 2007]. In contrast, the specific FLR treatment used in this study has none of the debilitating secondary effects seen in dermabrasion therapy.…”

Reversing the aging stromal phenotype prevents carcinoma initiation

“…lasers, topical chemotherapy (5-fluorouracil, imiquimod), have never achieved the same level of effectiveness as dermabrasion [45-49]. In fact, studies of the efficacy of these modalities often use dermabrasion as the gold standard for NMSC prophylaxis [50]. …”