Conflict of interest: none declared.
Photodynamic therapy with topical methyl aminolaevulinate for ‘difficult-to-treat’ basal cell carcinoma
Article first published online: 11 APR 2005
British Journal of Dermatology
Volume 152, Issue 4, pages 765–772, April 2005
How to Cite
Vinciullo, C., Elliott, T., Francis, D., Gebauer, K., Spelman, L., Nguyen, R., Weightman, W., Sheridan, A., Reid, C., Czarnecki, D. and Murrell, D. (2005), Photodynamic therapy with topical methyl aminolaevulinate for ‘difficult-to-treat’ basal cell carcinoma. British Journal of Dermatology, 152: 765–772. doi: 10.1111/j.1365-2133.2005.06484.x
- Issue published online: 11 APR 2005
- Article first published online: 11 APR 2005
- Accepted for publication 22 September 2004
- basal cell carcinoma;
- methyl aminolaevulinate;
- topical photodynamic therapy
Background Basal cell carcinoma (BCC) may be difficult to treat by conventional means, particularly if the lesions are large or located in the mid-face (H-zone). Photodynamic therapy (PDT) using topical methyl aminolaevulinate (MAL) may be a good noninvasive option for these patients.
Objectives To investigate the efficacy and safety of PDT using MAL for BCCs defined as ‘difficult to treat’, i.e. large lesions, in the H-zone, or in patients at high risk of surgical complications.
Methods This was a prospective, multicentre, noncomparative study. Patients were assessed 3, 12 and 24 months after the last PDT treatment. One hundred and two patients with ‘difficult-to-treat’ BCC were treated with MAL PDT, using 160 mg g−1 cream and 75 J cm−2 red light (570–670 nm), after lesion preparation and 3 h of cream exposure.
Results Ninety-five patients with 148 lesions were included in the per protocol analysis. The histologically confirmed lesion complete response rate at 3 months was 89% (131 of 148). At 12 months, 10 lesions had reappeared, and therefore the cumulative treatment failure rate was 18% (27 of 148). At 24 months, an additional nine lesions had reappeared, resulting in a cumulative treatment failure rate of 24% (36 of 148). The estimated sustained lesion complete response rate (assessed using a time-to-event approach) was 90% at 3 months, 84% at 12 months and 78% at 24 months. Overall cosmetic outcome was judged as excellent or good in 79% and 84% of the patients at 12 and 24 months, respectively. Follow-up is continuing for up to 5 years.
Conclusions MAL PDT is an attractive option for ‘difficult-to-treat’ BCC. Because of the excellent cosmetic results, the treatment is particularly well suited for lesions that would otherwise require extensive surgical procedures.