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As the incidence of non-melanoma skin cancer (NMSC) is increasing, there is a growing need to identify effective preventive strategies. A recently proposed hypothesis states that NMSC photocarcinogenesis is tightly linked to insufficient insulin growth factor-1 expression by agglomerated senescent fibroblasts in geriatric dermis. This paucity of IGF-1 expression in senile skin allows basal keratinocytes to mitotically propagate their UVB-altered genome and potentially initiate an actinic neoplasm. Here, we review the role of the dermal microenvironment in NMSC pathogenesis, describe the impact of fibroblast senescence on this process, and discuss how laser-induced dermal wounding can be effectively used to prevent NMSC development in geriatric patients.