title: Optimized photodynamic therapy with systemic photosensitizer following debulking technique for nonmelanoma skin cancers.
abstract: BACKGROUND
  The thickness and depth of invasion of skin tumors may be limiting factors for topical photosensitizer-based photodynamic therapy (PDT). The use of PDT with systemic photosensitizer needs to be further explored as a modality of treatment for nonmelanoma skin cancer (NMSC).
  
  
  OBJECTIVE
  The objective was to present six patients with multiple, nodular, and/or pigmented NMSC treated successfully with purified hematoporphyrin derivative (PHD) and PDT using prior debulking.
  
  
  METHODS
  After 24 hours of systemic PHD (1.5 mg/kg), 12 lesions of NMSC were selected for PHD-PDT alone and 6 nodular/elevated lesions for PHD-PDT following a debulking procedure. The tumor area was illuminated in one single-dose session of 300 J/cm(2), at an intensity range of 130 to 150 mW/cm(2), with a 630-nm-wavelength diode laser.
  
  
  RESULTS
  The prior curettage provided significant reduction in volume and/or pigmentation of lesions. After the session of PHD-PDT with prior curettage and additional topical 20% ALA-PDT in two lesions or PHD-PDT alone, 83% (5/6) of lesions and 58% (7/12) of lesions, respectively, maintained a complete clinical response, 22.2+/-8.9 months of follow-up.
  
  
  CONCLUSIONS
  The combination of prior debulking with systemic agents-PDT appears to be a good option for multiple, pigmented, and/or nodular lesions of NMSC and can allow the improvement of clinical results.
authors.affiliation: Division of Dermatology of the School of Medicine of Ribeirão Preto, University of São Paulo, São Carlos, São Paulo, Brazil. cssouza@fmrp.usp.br
authors.forename: Cacilda S
authors.initials: CS
authors.lastname: Souza
authors.forename: Ana B S
authors.initials: AB
authors.lastname: Neves
authors.forename: Lília A B
authors.initials: LA
authors.lastname: Felício
authors.forename: Juliana
authors.initials: J
authors.lastname: Ferreira
authors.forename: Cristina
authors.initials: C
authors.lastname: Kurachi
authors.forename: Vanderlei S
authors.initials: VS
authors.lastname: Bagnato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005148:Facial Dermatoses / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents