High-frequency high-intensity focused ultrasound (HF-HIFU) for ablation of benign, premalignant, and malignant cutaneous lesions: a systematic review.

High-frequency high-intensity focused ultrasound (HF-HIFU) is a non-invasive ablative technology that enables precise, depth-controlled thermal destruction of superficial cutaneous lesions. Its potential dermatological applications include benign, premalignant, and selected malignant tumours; however, current evidence is fragmented across indications and study designs. This systematic review evaluated the clinical role of HF-HIFU for cutaneous lesion ablation. The review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420261326294). Eligible studies investigated HF-HIFU for benign, premalignant, or malignant skin lesions. Methodological quality was assessed using the Newcastle-Ottawa Scale and the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Given substantial heterogeneity in lesion types, treatment parameters, and outcome reporting, results were synthesized narratively with pooled descriptive outcomes. Fifteen studies including 92 patients treated with a 20-MHz dermatological HF-HIFU system were analysed. For malignant lesions, lesion-level analysis suggested high initial clearance rates (96%, n=28), although evidence was limited and largely noncomparative. Actinic keratosis demonstrated complete clearance rates exceeding 70%, with additional partial responses in most remaining lesions. Outcomes for benign lesions varied by depth and histology, with best results in superficial epithelial tumours and lower efficacy for deeper dermal lesions. Procedural pain depended on anatomical location and treatment extent, being higher in head-and-neck and acral lesions. Adverse events were predictable, and transient. Follow-up was generally short, and histological confirmation was infrequent. HF-HIFU appears to be a promising minimally invasive option for selected cutaneous lesions, but larger prospective studies with long-term follow-up and routine histological verification are needed to define its clinical role.