What is the efficacy of photodynamic therapy (PDT) for the treatment for basal cell carcinoma (BCC)?

Updated: Mar 02, 2020
  • Author: Robert S Bader, MD; Chief Editor: William D James, MD  more...
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Answer

Although its use is off label, PDT has been used for treatment and prevention of BCCs, including those patients with immunosuppression and nevoid BCC syndrome. Shallow tumors, such as superficial BCCs, respond most consistently. Surgical excision has been shown to be significantly more effective than ALA-PDT in the treatment of nodular BCC. [93]

The strongest support for PDT as a modality for BCCs comes with data on thin lesions treated with methylaminolevulinate (used outside the United States), but at least one long-term follow-up trial has also shown surgical excision to be superior. [94]

Christensen et al reported a 10-year lesion complete response rate of 87% with two sessions of dimetylsulfoxide-supported topical 5-aminolaevulinic acid-PDT and curettage for primary, small BCC. Favourable cosmetic outcomes also were reported for nearly all cases. [95]

Various protocols have been followed to achieve varying levels of success—increasing incubation time, increasing occlusion time, and using longer and/or deeper-penetrating wavelengths of light (eg, red light or pulse-dye laser). Many patients continue to prefer PDT because of its short healing time, excellent cosmesis, and relative affordability.

Also see the British Association of Dermatologists Therapy Guidelines and Audit Subcommittee’s clinical guidelines summary, Guidelines for topical photodynamic therapy: update. [90]


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