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Consensus recommendations for the treatment of basal cell carcinomas in Gorlin syndrome with topical methylaminolaevulinate-photodynamic therapy

Authors


  • Conflict of interest

    • NBS is a consultant and investigator for Galderma, Meda, Léo, Roche, Novartis. RB is a consultant and has received research grant or honorarium from Galderma, Photocure DUSA Pharmaceuticals. CG is a consultant for Galderma. MH has received research grant or honorarium from Almirall, Galderma, Leo Pharma, Pantec and Procter & Gamble. JTL has received honoraria for speaking and advisory boards from Almirall, Leo, Galderma, Gsk and Basilea. CP declares no conflict of interest. SP has received honoraria for speaking and advisory boards from Abbott, Jannsen-Cilag, Galderma, MSD, Novartis and Pfizer.
  • Funding sources

    • The meeting was organized by Galderma during the XIIth Euro-PDT meeting in Copenhagen in May 2012. Dermatologists were invited based on their expertise with PDT and the fact that they had practical experience in treating patients with BCC. Dermatologists did not receive honorarium from Galderma or other sponsors for their participation in this consensus meeting.
  • The recommendations set forth in this article have been prepared for dermatologists and reflect the best data available, including published reports and the experts' own experience, at the time this report was prepared. The results of future studies may require alteration of the conclusions or recommendations of this report. It may be necessary to depart from the recommendations in the interests of specific patients or under special circumstances. Just as adherence to these recommendations may not constitute a defence against a claim of negligence, so deviation from them should not necessarily be deemed negligent. Indications of MAL-PDT vary according to individual country approvals, and the consensus recommendations described here may not be approved in all countries.

Abstract

Background

Patients with Gorlin syndrome develop multiple basal cell carcinomas (BCC), for which treatment is often difficult. Methylaminolevulinate-photodynamic therapy (MAL-PDT) is approved for the treatment of superficial and nodular BCCs in Canada and several European countries.

Objectives

To establish consensus recommendations for the use of MAL-PDT in patients with Gorlin syndrome.

Methods

The Gorlin consensus panel was comprised of 7 dermatologists who had treated a total of 83 patients with Gorlin syndrome using MAL-PDT. Consensus was developed based on the personal experience of the expert and results of literature review (on PUBMED using the keywords ‘MAL’ and ‘PDT’ and ‘Gorlin’ or ‘naevoid basal cell carcinoma syndrome’).

Results

Consensus was reached among the experts and the literature review identified 9 relevant reports. The experts considered MAL-PDT a generally effective and safe therapy for treatment of BCC in Gorlin syndrome. For superficial BCC (sBCC), all sizes can be treated, and in nodular BCC (nBCC), better efficacy can be achieved in thinner lesions (<2 mm in thickness). MAL-PDT treatment schedule should be performed according to labelling although in individual cases, it may be adapted and performed on a monthly basis based on clinical assessment. Follow-up should be related to frequency of recurrence, and severity, number and location of lesions. Multiple lesions and large areas may be treated during the same session; however, adequate pain management should be considered.

Conclusions

MAL-PDT is safe and effective in patients with Gorlin syndrome. Utilization of these recommendations may improve efficacy and clearance rates in this population.

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