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Objectives: Under the name of Non Melanoma Skin Cancer (NMSC) we describe all the non-melanoma malignant neoplasms affecting the skin. However, especially epidemiologically, the term NMSC practically refers to keratinocyte carcinomas, namely basal (BCC) and squamous cell carcinoma (SCC), since they account for the 99% of the tumors in this group. Malignant disease of the skin include also: Merkel Cell Carcinoma, Cutaneous T-cell Lymphoma, Kaposi sarcoma, Extra-mammary Paget disease, apocrine carcinoma and metastatic malignancies from various primary sites.

Introduction: NMSC is the most commonly occurring cancer. They account for less than 0,1% of patients deaths caused by cancer. The incidence of NMSC is 18–20 times higher than that of melanoma. However, compared to melanoma, the epidemiology of NMSC is understudied. There are significant limitations in the investigation of NMSC incidence, mainly attributed to its marked geographic variability, as well as to the fact that large cancer registries usually exclude NMSC from their records, or the records are incomplete.

Materials / method: The most well recognized exogenous factor implicated in the pathogenesis of NMSC is the ultraviolet radiation (UVR). In Western societies, tan-seeking behavior, including sunbathing and indoor tanning, outdoor activities without adequate sun protection, clothing style and ozone depletion are among the parameters contributing to the increased UVR-exposure.

Results: We describe the two main types of NMSC: basal cell carcinoma and squamous cell carcinoma. We will also look at new treatments available for these diseases. In a third part, we will discuss Merkel's carcinoma, due to its high mortality and the latest therapeutic revolutions with the advent of immunotherapy in this indication.

Conclusion: Apart from environmental changes, another crucial reason for a further future increase of the NMSC incidence is the prolonged life expectancy. By 2050, it is expected that 32% of the world population will be above the age of 60. Given the predilection of keratinocyte cancers for the elderly, it is reasonable that NMSC will follow this age increase.

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Objectives: - To describe a combined treatment of hypertrophic and keloid scars with intra-lesional injection of corticosteroids and laser-assisted corticosteroid delivery

Introduction: Hypertrophic and keloid scars result from an abnormal hyperproliferation of dermal fibroblasts with increased depositions of collagen in the wound. Injected or topical corticosteroids are one of the best treatment options despite a limited effectiveness and a high recurrence rate. Ablative fractional lasers (AFL) can create vertical channels to enhance topical drug delivery deep into the dermis. In this way, laser-assisted corticosteroid delivery (LACD) can be an alternative or a complementary treatment to intra-lesional injections of steroids (ILIS).

Materials / method: The concept of LACD has been first developed in 2013 by Waibel et al. on 15 subjects undergoing 10600 nm CO2 AFL followed by application of triamcinolone acetonide, with an overall improvement after 3 to 5 sessions. This idea was later developed with a longer protocol (median of nine sessions) combining 2940 nm erbium AFL followed by betamethasone cream b.i.d., with poor results on ear and neck keloids and 22% of recurrence. Park et al. compared ILIS and topical application of corticosteroids after erbium AFL on the same keloid, with no significant difference between the two techniques.

Results: We developed a new protocol combining 10600 nm CO2 AFL (10 Watts, density 5%, index 8) followed by the application of triamcinolone acetonide 40 mg/mL, delivered in the deep dermis through the vertical channels. The originality of our protocol was to combine LACD to ILIS of a minimal amount of triamcinolone acetonide 40 mg/mL on the thickest parts of the scar. This protocol was performed on 15 hypertrophic and keloid scars with resolution of symptoms and complete flattening of the scars after only 1 to 3 sessions at 6-weeks interval, and no recurrence after 6-months follow-up.

Conclusion: This association allows faster improvement of scars than LACD used alone, with significant results after only 2-3 sessions. Limiting the amount of injected steroids leads to reduce the risk of fat atrophy and telangiectasias, reduce the pain, and improve the uniformity of steroids into the scar. Finally, the collagen remodeling role of AFL is an additional explanation for the better results of this association. Combining LACD and ILIS is an interesting protocol, not reported so far. Further prospective studies are needed to confirm the results and the settings of our protocol.

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