Topical methyl aminolaevulinate photodynamic therapy in patients with basal cell carcinoma prone to complications and poor cosmetic outcome with conventional treatment

Authors

  • M. Horn,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • P. Wolf,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • H.C. Wulf,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • T. Warloe,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • C. Fritsch,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • L.E. Rhodes,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • R. Kaufmann,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • M. De Rie,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • F.J. Legat,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • I.M. Stender,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • A.M. Solér,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • A-M. Wennberg,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • G.A.E. Wong,

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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  • O. Larkö

    1. Departments of Photodermatology and Dermatology, Karl-Franzens-University, Auenbruggerplatz 8, A-8036 Graz, Austria
      *Bispebjerg Hospital Copenhagen, Denmark
      †The Radium Hospital Oslo, Norway
      ‡Heinrich-Heine University of Düsseldorf, Germany
      §Royal Liverpool University Hospital, Liverpool, U.K.
      ¶Goethe University of Frankfurt, Germany
      **Academic Medical Center, University of Amsterdam, The Netherlands
      ††Sahlgrenska University, Gothenburg, Sweden
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Peter Wolf, MD. Tel.: + 43 316385 2371. Fax: + 43 316385 2466. E-mail: peter.wolf@uni-graz.at

Summary

Background  Conventional treatment of basal cell carcinoma (BCC) causes morbidity and/or disfigurement in some patients because of the location (e.g. mid-face) and size of the lesion.

Objectives  Following reports that such difficult-to-treat BCC lesions have been treated successfully with topical methyl aminolaevulinate (MAL) photodynamic therapy (PDT), a multicentre study was performed to determine the response of such BCC to MAL-PDT.

Methods  An open, uncontrolled, prospective, multicentre study was conducted comprising patients with superficial and/or nodular BCC who were at risk of complications, poor cosmetic outcome, disfigurement and/or recurrence using conventional therapy. Patients were given one or two cycles within 3 months of topical MAL-PDT, each consisting of two treatments 1 week apart. Tumour response was assessed clinically at 3 months after the last PDT, with histological confirmation of all lesions in clinical remission. The cosmetic outcome was rated. Patients with a BCC in remission will be followed up for 5 years for recurrence, of which the 24-month follow-up is reported here. Ninety-four patients with 123 lesions were enrolled and treated with MAL-PDT at nine European primary care and referral university hospitals. An independent blinded study review board (SRB) retrospectively excluded nine patients and a total of 15 lesions from the efficacy analysis, for not having a difficult-to-treat BCC according to the protocol.

Results  The lesion remission rate at 3 months was 92% (45 of 49) for superficial BCC, 87% (45 of 52) for nodular BCC, and 57% (four of seven) for mixed BCC, as assessed by clinical examination, and 85% (40 of 47), 75% (38 of 51), and 43% (three of seven), respectively, as assessed by histological examination and verified by the SRB. At 24 months after treatment, the overall lesion recurrence rate was 18% (12 of 66). The cosmetic outcome was graded as excellent or good by the investigators in 76% of the cases after 3 months follow-up, rising to 85% at 12 months follow-up, and 94% at 24 months follow-up.

Conclusions  Topical MAL-PDT is effective in treating BCC at risk of complications and poor cosmetic outcome using conventional therapy. MAL-PDT preserves the skin and shows favourable cosmetic results.

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