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Bowen’s disease, solar keratoses and superficial basal cell carcinomas treated by photodynamic therapy using a large-field incoherent light source

Authors

  • S. Varma,

    1. Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, U.K.
      *Department of Dermatology, St John’s Institute of Dermatology, London, U.K.
      †Department of Dermatology, Queens Medical Centre, Nottingham, U.K.
      ‡University of Wales College of Medicine, U.K.
      §Gloucestershire Royal Hospital, Gloucester, U.K.
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  • H. Wilson,

    1. Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, U.K.
      *Department of Dermatology, St John’s Institute of Dermatology, London, U.K.
      †Department of Dermatology, Queens Medical Centre, Nottingham, U.K.
      ‡University of Wales College of Medicine, U.K.
      §Gloucestershire Royal Hospital, Gloucester, U.K.
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  • H.A. Kurwa,

    1. Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, U.K.
      *Department of Dermatology, St John’s Institute of Dermatology, London, U.K.
      †Department of Dermatology, Queens Medical Centre, Nottingham, U.K.
      ‡University of Wales College of Medicine, U.K.
      §Gloucestershire Royal Hospital, Gloucester, U.K.
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  • B. Gambles,

    1. Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, U.K.
      *Department of Dermatology, St John’s Institute of Dermatology, London, U.K.
      †Department of Dermatology, Queens Medical Centre, Nottingham, U.K.
      ‡University of Wales College of Medicine, U.K.
      §Gloucestershire Royal Hospital, Gloucester, U.K.
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  • C. Charman,

    1. Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, U.K.
      *Department of Dermatology, St John’s Institute of Dermatology, London, U.K.
      †Department of Dermatology, Queens Medical Centre, Nottingham, U.K.
      ‡University of Wales College of Medicine, U.K.
      §Gloucestershire Royal Hospital, Gloucester, U.K.
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  • A.D. Pearse,

    1. Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, U.K.
      *Department of Dermatology, St John’s Institute of Dermatology, London, U.K.
      †Department of Dermatology, Queens Medical Centre, Nottingham, U.K.
      ‡University of Wales College of Medicine, U.K.
      §Gloucestershire Royal Hospital, Gloucester, U.K.
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  • ‡ D. Taylor,

    1. Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, U.K.
      *Department of Dermatology, St John’s Institute of Dermatology, London, U.K.
      †Department of Dermatology, Queens Medical Centre, Nottingham, U.K.
      ‡University of Wales College of Medicine, U.K.
      §Gloucestershire Royal Hospital, Gloucester, U.K.
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  • A.V. Anstey

    1. Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, U.K.
      *Department of Dermatology, St John’s Institute of Dermatology, London, U.K.
      †Department of Dermatology, Queens Medical Centre, Nottingham, U.K.
      ‡University of Wales College of Medicine, U.K.
      §Gloucestershire Royal Hospital, Gloucester, U.K.
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Dr Sandeep Varma. E-mail: varma@doctors.org.uk

Abstract

Background  Photodynamic therapy (PDT) has not yet been demonstrated to be superior to conventional treatment in the treatment of superficial skin cancers and premalignant skin conditions. A limitation for PDT is the absence to date of a light source suitable for the treatment of larger lesions or ‘field changes’ where several lesions are present on one anatomical site.

Objectives  To investigate the safety and efficacy of a large field light source, the Waldmann PDT 1200, in the treatment of Bowen’s disease (BD), superficial basal cell carcinomas (BCCs) and solar keratoses (SKs).

Methods  After application of 5-aminolaevulinic acid for 4–6 h, each lesion was irradiated with 105 J cm−2 of incoherent red light centred on 640 nm. Eighty-eight patients with 239 lesions were recruited.

Results  Within two treatments, 88% of BD lesions, 95% of BCCs and 99% of SKs showed complete clinical clearance. At 12 months the complete response rates were 69% for BD, 82% for BCC and 72% for SK.

Conclusions  This study confirms that PDT is a useful treatment and that selected superficial BCCs and SKs respond well to PDT. The PDT 1200 light source proved capable of treating multiple lesions amounting to a ‘field change’ and also lesions up to 10 cm in diameter within an acceptable treatment time. Thus far, PDT has failed to become established as a routine treatment for small premalignant and malignant skin lesions as it has not proved superior to simple cheaper conventional therapies such as cryotherapy, curettage and cautery, topical chemotherapy with 5-fluorouracil, or surgery. However, PDT has become established as a treatment for selected cases in some centres. This study suggests a role for PDT in the treatment of large premalignancies, superficial BCCs and field change where existing treatments may be problematic.

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