Bowen's disease, solar keratoses and superficial basal cell carcinomas treated by photodynamic therapy using a large-field incoherent light source.
BACKGROUND
Photodynamic therapy (PDT) has not yet been demonstrated to be superior to conventional treatment in the treatment of superficial skin cancers and premalignant skin conditions. A limitation for PDT is the absence to date of a light source suitable for the treatment of larger lesions or 'field changes' where several lesions are present on one anatomical site.


OBJECTIVE
To investigate the safety and efficacy of a large field light source, the Waldmann PDT 1200, in the treatment of Bowen's disease (BD), superficial basal cell carcinomas (BCCs) and solar keratoses (SKs).


METHODS
After application of 5-aminolaevulinic acid for 4-6 h, each lesion was irradiated with 105 J cm-2 of incoherent red light centred on 640 nm. Eighty-eight patients with 239 lesions were recruited.


RESULTS
Within two treatments, 88% of BD lesions, 95% of BCCs and 99% of SKs showed complete clinical clearance. At 12 months the complete response rates were 69% for BD, 82% for BCC and 72% for SK.


CONCLUSIONS
This study confirms that PDT is a useful treatment and that selected superficial BCCs and SKs respond well to PDT. The PDT 1200 light source proved capable of treating multiple lesions amounting to a 'field change' and also lesions up to 10 cm in diameter within an acceptable treatment time. Thus far, PDT has failed to become established as a routine treatment for small premalignant and malignant skin lesions as it has not proved superior to simple cheaper conventional therapies such as cryotherapy, curettage and cautery, topical chemotherapy with 5-fluorouracil, or surgery. However, PDT has become established as a treatment for selected cases in some centres. This study suggests a role for PDT in the treatment of large premalignancies, superficial BCCs and field change where existing treatments may be problematic.
Varma
S
S
Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, U.K. varma@doctors.org.uk
Wilson
H
H
Kurwa
H A
HA
Gambles
B
B
Charman
C
C
Pearse
A D
AD
Taylor
D
D
Anstey
A V
AV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001913:Bowen's Disease / Q000188:drug therapy; D002280:Basal Cell Carcinoma / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007642:Keratosis / Q000188:drug therapy; D008029:Lighting; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D011230:Precancerous Conditions / Q000188:drug therapy*; D011832:Radiation Injuries / Q000188:drug therapy; D012008:Recurrence; D012878:Skin Neoplasms / Q000188:drug therapy*; D013472:Sunlight / Q000009:adverse effects; D016896:Treatment Outcome