Summary Several open studies report the efficacy of topical photodynamic therapy (PDT) for non-melanoma skin cancer (NMSC) and precursor lesions. PDT may also be effective in various inflammatory and infectious dermatoses. As a tissue sparing modality, PDT may be preferable for large and/or multiple lesions and those in sites where disfigurement or poor healing from conventional therapies is a particular risk. Limited comparison data confirms that topical PDT achieves superior cosmesis to conventional therapies in actinic keratoses, squamous cell carcinoma in-situ and basal cell carcinoma. This review assesses the current data and proposes potential future applications for topical PDT including the treatment of photo-damaged skin.