基底细胞癌（BCC）是最常见的皮肤肿瘤，每年发病率不断增加。标准治疗需要进行多次诊断和治疗。光学相干断层扫描（OCT）作为一种诊断工具，增加了BCC诊断的敏感度（95%）和特异度（77%）。虽然激光疗法不是标准治疗，但长脉冲1064nm Nd:YAG激光似乎是一种有前途的选择。然而，数据不足。以往的论文跟踪过程短，而且使用的方法在某种程度上较差，难以检测完全的肿瘤清除情况。为了填补这一研究空白，本研究通过FU OCT评估了激光治疗的效果。我们采取以病人为中心的方法，在一次手术中组合OCT和Nd:YAG激光治疗。该研究是一项前瞻性的单中心试验，招募了经活检或OCT证实的BCC患者，肿瘤厚度小于1.2mm。患者在Nd:YAG激光（5-6mm斑点，120-140J/cm2光强，8-10毫秒脉冲持续时间）的两到三个重复疗程中接受治疗。每个BCC在基线和激光治疗后3个月和12个月通过临床影像、皮肤镜和OCT评估。不完全肿瘤清除（ITC）的定义是在处理区域内OCT图像中明显可见的BCC或经活检证实的BCC。共45名患者完成了12个月的FU（46.7%女性，年龄中位数为74.0[52-88]岁），共有78个BCC病变。在基线时，所有患者的BCC均通过OCT诊断（肿瘤厚度为0.6[0.4；0.8]mm），15.4%病变还添加了组织病理学诊断。BCC最常见的亚型是表浅型（48.7%），其次是结节型（47.4%）和浸润型（3.8%）。经过Nd:YAG激光治疗后，ITC率在3个月和12个月后分别为30.8%（95% CI：20.8%-42.2%）（24/78）和7.4%（95% CI：2.1%-17.9%）（4/54）。ITC与组织学亚型、肿瘤厚度或位置无关。如果检测到ITC，则进行再次治疗。在至少接受过一次额外激光治疗的19个病变中，有7个病变（36.8%）未能完全去除肿瘤。在治疗的病变中，46.7%的病变在经过12个月后的美容结果评估为中度或重度瘢痕形成。我们的研究结果表明，使用Nd:YAG激光治疗的BCC的ITC率比之前报道的要高得多（高达三分之一），虽然激光设置与以往研究相同。这在3个月的FU中特别明显。此外，我们目睹了更多的副作用和更糟糕的美容结果，与以前的研究相比在这方面差距更大。© 2023 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.

Basal cell carcinoma (BCC) is the most common skin tumor with an annually increasing incidence. Standard care requires several visits for diagnosis and treatment. Optical coherence tomography (OCT) as a diagnostic tool increases the sensitivity (95%) and specificity (77%) of the diagnosis of BCC. Although laser therapy is not the standard of care, the long-pulsed 1064 nm Nd:YAG laser seems to be a promising option. However, data are scarce. The published papers had a short follow-up (FU) time and used to some extent inferior methods to detect complete tumor clearance. To address this research gap, this study evaluates the efficiency of laser treatment by FU OCT. We pursue a patient-focused approach and combine OCT with Nd:YAG laser treatment in one procedure.The study was conducted as a prospective, single-center trial that recruited biopsy-confirmed or OCT-proven BCC with a tumor thickness of less than 1.2 mm. Patients underwent two or three repeated sessions with the Nd:YAG laser (5-6 mm spot, fluence of 120-140 J/cm2 , pulse duration of 8-10 milliseconds). Each BCC was assessed at baseline, and 3 and 12 months after laser treatment by clinical image, dermoscopy, and OCT. Incomplete tumor clearance (ITC) was defined as a clearly detectable BCC on the OCT image or a biopsy-confirmed BCC in the treated area.Forty-five patients completed the 12-month FU (46.7% women; median age of 74.0 [52-88] years) with a total number of 78 BCC lesions. At baseline, all patients had their BCC diagnosed by OCT (tumor thickness of 0.6 [0.4; 0.8] mm), 15.4% lesions were additionally diagnosed by histopathology. The most common subtype of BCC was superficial (48.7%), followed by nodular (47.4%) and infiltrative (3.8%). ITC rate after the treatment using Nd:YAG laser was 30.8% (95% CI: 20.8%-42.2%) (24/78) after 3 months and 7.4% (95% CI: 2.1%-17.9%) (4/54) after 12 months. ITC was not associated with histological subtype, tumor thickness, or location. If ITC was detected, the lesion was treated again. Out of 19 lesions with at least one additional laser treatment, 7 lesions (36.8%) suffered from incomplete tumor removal. In 46.7% of the treated lesions, the cosmetic outcome was rated as moderate or severe scarring after 12 months.Our results demonstrate that the ITC rate of BCC treated with the Nd:YAG laser is much higher (up to one-third) than reported, although the laser settings were identical to prior studies. This is especially evident at the 3-month FU. In addition, we witnessed a larger number of side effects and a worse cosmetic outcome compared to previous studies.© 2023 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.