Abstract
PURPOSE Melanoma is a rare form of skin cancer, making up only 4% of all skin cancers, but it accounts for 75% of all skin cancer-related mortality, making the exploration of safe treatments a necessity. As a cutaneous tumor, Melanoma is one of few cancers capable of being treated with laser ablation, yet this treatment is often overlooked in favor of surgical approaches or. It has been used in limited amounts to treat basal cell carcinoma, actinic keratosis, and melanoma with great effect. Studies show that laser ablation, with local anesthesia, results in positive outcomes and fewer recurrences in melanoma, as well as less pain and scarring than traditional treatments such as excision. Mohs surgery, while generally preferred, is somewhat limited when it comes to areas like the eyes. It is in these areas that laser ablation has the opportunity to excel, as with its precision it can be used to treat choroidal melanoma with limited damage and preservation of optic function. While restricted in high-stage tumors, laser ablation use can be expanded to provide rapid treatment for patients with melanoma where surgical approaches are of limited use. METHODS This is a retrospective cohort study of patients diagnosed with cutaneous Melanoma between 2004-2020 in the National Cancer Database (NCDB) who underwent the procedure of the primary site by local tumor destruction with laser ablation or laser excision. Descriptive statistics were analyzed via frequency for the year of diagnosis, sex, race, education level, income level, geographic area, Charlson-Deyo Score, tumor stage, and primary site. Overall survival was determined via the Kaplan-Meier test. RESULTS Since 2004, there has been a general decrease in laser procedures. The majority of patients were White, male, above the average education level, and earned above the average income level. The average patient was 62.4 years old, lived 20 miles from the treatment facility, and was relatively healthy with 89.6% at a Charlson-Deyo comorbidity score of 0. 60.1% of the cases were treated at an early stage. The most common primary site for laser treatment was the skin of the trunk, followed by skin of the lower limb and hip, and patients had a median overall survival of 88.4 months CONCLUSION Though its potential value as a treatment remains high, laser ablation use is lowering and is used in wealthy White patients, likely due to the lower rates and delayed diagnosis experienced by patients with darker skin. The long median survival time shows that despite the low use, Laser ablation is highly effective at treating melanoma, as with a median time of ∼7 years, many patients will die from unrelated conditions. What use there is could be optimized, as there are strikingly few uses in the eyes, where it is most useful. Future research should look into what factors patients consider when choosing laser over surgical resection to better understand social factors in treatment.