Laser Therapy in Basal Cell Carcinoma: Current Evidence, Literature Gaps and Future Perspectives

Basal cell carcinoma (BCC) is the most frequent skin cancer, and surgery remains the treatment of choice, particularly in high-risk subtypes and sites. However, in low-risk cases and in patients where cosmetic outcome is a priority, alternative strategies, including laser therapy, have been proposed. Different laser sources offer potential advantages in terms of minimal invasiveness, healing time, and cosmetic outcome, but their clinical role remains a matter of debate. This narrative review critically analyses the available evidence on the use of lasers in the treatment of basal cell carcinoma, with a focus on ablative lasers, vascular lasers, and laser-assisted photodynamic therapy. Mechanisms of action, main clinical results, limitations, and the emerging contribution of non-invasive imaging for case selection and response monitoring are discussed. Ablative lasers, in particular CO2, show favourable results in superficial low-risk BCC, while clearance reliability decreases with increasing tumour depth. Vascular lasers may offer short-term control in selected lesions but with limited long-term data. Laser-assisted PDT represents a promising strategy to extend the indication of PDT to selected nodular forms. Overall, the literature is limited by methodological heterogeneity, incomplete stratification, and short follow-ups. Well-designed comparative studies, standardised protocols, and objective controls will be essential to define the real clinical space of laser therapy in basal cell carcinoma.