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Photodynamic therapy with topical methyl aminolaevulinate for ‘difficult-to-treat’ basal cell carcinoma

Authors

  • C. Vinciullo,

    1. Dermatology Surgery and Laser Centre, PO Box 8115, South Perth, Western Australia 6151, Australia
      *Fremantle Hospital, Fremantle, Western Australia, Australia
      †Southeastern Dermatology, Carina, Brisbane, Queensland, Australia
      ‡Queen Elizabeth Hospital, Adelaide, South Australia, Australia
      §Royal Adelaide Hospital, Adelaide, South Australia, Australia
      ¶Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia
      **The St George Hospital, University of New South Wales, Kogarah, Sydney, New South Wales, Australia
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  • T. Elliott,

    1. Dermatology Surgery and Laser Centre, PO Box 8115, South Perth, Western Australia 6151, Australia
      *Fremantle Hospital, Fremantle, Western Australia, Australia
      †Southeastern Dermatology, Carina, Brisbane, Queensland, Australia
      ‡Queen Elizabeth Hospital, Adelaide, South Australia, Australia
      §Royal Adelaide Hospital, Adelaide, South Australia, Australia
      ¶Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia
      **The St George Hospital, University of New South Wales, Kogarah, Sydney, New South Wales, Australia
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  • D. Francis,

    1. Dermatology Surgery and Laser Centre, PO Box 8115, South Perth, Western Australia 6151, Australia
      *Fremantle Hospital, Fremantle, Western Australia, Australia
      †Southeastern Dermatology, Carina, Brisbane, Queensland, Australia
      ‡Queen Elizabeth Hospital, Adelaide, South Australia, Australia
      §Royal Adelaide Hospital, Adelaide, South Australia, Australia
      ¶Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia
      **The St George Hospital, University of New South Wales, Kogarah, Sydney, New South Wales, Australia
    Search for more papers by this author
  • K. Gebauer,

    1. Dermatology Surgery and Laser Centre, PO Box 8115, South Perth, Western Australia 6151, Australia
      *Fremantle Hospital, Fremantle, Western Australia, Australia
      †Southeastern Dermatology, Carina, Brisbane, Queensland, Australia
      ‡Queen Elizabeth Hospital, Adelaide, South Australia, Australia
      §Royal Adelaide Hospital, Adelaide, South Australia, Australia
      ¶Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia
      **The St George Hospital, University of New South Wales, Kogarah, Sydney, New South Wales, Australia
    Search for more papers by this author
  • L. Spelman,

    1. Dermatology Surgery and Laser Centre, PO Box 8115, South Perth, Western Australia 6151, Australia
      *Fremantle Hospital, Fremantle, Western Australia, Australia
      †Southeastern Dermatology, Carina, Brisbane, Queensland, Australia
      ‡Queen Elizabeth Hospital, Adelaide, South Australia, Australia
      §Royal Adelaide Hospital, Adelaide, South Australia, Australia
      ¶Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia
      **The St George Hospital, University of New South Wales, Kogarah, Sydney, New South Wales, Australia
    Search for more papers by this author
  • R. Nguyen,

    1. Dermatology Surgery and Laser Centre, PO Box 8115, South Perth, Western Australia 6151, Australia
      *Fremantle Hospital, Fremantle, Western Australia, Australia
      †Southeastern Dermatology, Carina, Brisbane, Queensland, Australia
      ‡Queen Elizabeth Hospital, Adelaide, South Australia, Australia
      §Royal Adelaide Hospital, Adelaide, South Australia, Australia
      ¶Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia
      **The St George Hospital, University of New South Wales, Kogarah, Sydney, New South Wales, Australia
    Search for more papers by this author
  • W. Weightman,

    1. Dermatology Surgery and Laser Centre, PO Box 8115, South Perth, Western Australia 6151, Australia
      *Fremantle Hospital, Fremantle, Western Australia, Australia
      †Southeastern Dermatology, Carina, Brisbane, Queensland, Australia
      ‡Queen Elizabeth Hospital, Adelaide, South Australia, Australia
      §Royal Adelaide Hospital, Adelaide, South Australia, Australia
      ¶Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia
      **The St George Hospital, University of New South Wales, Kogarah, Sydney, New South Wales, Australia
    Search for more papers by this author
  • A. Sheridan,

    1. Dermatology Surgery and Laser Centre, PO Box 8115, South Perth, Western Australia 6151, Australia
      *Fremantle Hospital, Fremantle, Western Australia, Australia
      †Southeastern Dermatology, Carina, Brisbane, Queensland, Australia
      ‡Queen Elizabeth Hospital, Adelaide, South Australia, Australia
      §Royal Adelaide Hospital, Adelaide, South Australia, Australia
      ¶Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia
      **The St George Hospital, University of New South Wales, Kogarah, Sydney, New South Wales, Australia
    Search for more papers by this author
  • C. Reid,

    1. Dermatology Surgery and Laser Centre, PO Box 8115, South Perth, Western Australia 6151, Australia
      *Fremantle Hospital, Fremantle, Western Australia, Australia
      †Southeastern Dermatology, Carina, Brisbane, Queensland, Australia
      ‡Queen Elizabeth Hospital, Adelaide, South Australia, Australia
      §Royal Adelaide Hospital, Adelaide, South Australia, Australia
      ¶Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia
      **The St George Hospital, University of New South Wales, Kogarah, Sydney, New South Wales, Australia
    Search for more papers by this author
  • D. Czarnecki,

    1. Dermatology Surgery and Laser Centre, PO Box 8115, South Perth, Western Australia 6151, Australia
      *Fremantle Hospital, Fremantle, Western Australia, Australia
      †Southeastern Dermatology, Carina, Brisbane, Queensland, Australia
      ‡Queen Elizabeth Hospital, Adelaide, South Australia, Australia
      §Royal Adelaide Hospital, Adelaide, South Australia, Australia
      ¶Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia
      **The St George Hospital, University of New South Wales, Kogarah, Sydney, New South Wales, Australia
    Search for more papers by this author
  • D. Murrell

    1. Dermatology Surgery and Laser Centre, PO Box 8115, South Perth, Western Australia 6151, Australia
      *Fremantle Hospital, Fremantle, Western Australia, Australia
      †Southeastern Dermatology, Carina, Brisbane, Queensland, Australia
      ‡Queen Elizabeth Hospital, Adelaide, South Australia, Australia
      §Royal Adelaide Hospital, Adelaide, South Australia, Australia
      ¶Austin and Repatriation Medical Centre, Heidelberg West, Victoria, Australia
      **The St George Hospital, University of New South Wales, Kogarah, Sydney, New South Wales, Australia
    Search for more papers by this author

  • Conflict of interest: none declared.

Carl Vinciullo.
E-mail: vinco@dermlaser.com.au

Summary

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.

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