title: Basal cell carcinoma treated successfully with combined CO2 laser and photodynamic therapy in a renal transplant patient: a case report.
abstract: Renal transplant recipients are at significantly greater risk of developing skin malignancies due to combination immunosuppressive therapy. A significant number of patients present with lesions needing excision at multiple outpatient follow-up visits. For basal cell carcinoma, we have recently described how combining CO(2) laser with Photodynamic therapy greatly increases the efficacy of long-term tumour clearance compared with each modality alone. We present a case of a 66-year-old renal transplant therapy patient who repeatedly presents with new skin malignancies, in whom we treated successfully with Laser-Photodynamic therapy in a see-and-treat setting. This therapy offers patients the possibility of better cosmetic and functional results whilst obviating the need for repeated surgery. Other pre-cancerous lesions such as solar keratoses are prevalent in this patient group and respond extremely well to Photodynamic therapy monotherapy. We propose a regular clinic for renal transplant patients in a laser facility equipped with CO(2) laser and Photodynamic therapy, histopathology and punch-biopsy materials. This strategy allows simple and effective treatment of multiple lesions simultaneously, avoidance of numerous operations, avoidance of non-essential outpatient appointments that result in booking furthers visits for treatment, whilst facilitating diagnostic biopsies of potentially malignant lesions. We outline a care pathway for a see-and-treat clinic that implements this novel treatment modality improving the care of this unique patient population.
authors.affiliation: Department of Burns and Plastic Surgery, Morriston Hospital Heol Maes Eglwys, Morriston, Swansea, SA6 6NL UK. kshokrollahi@hotmail.com
authors.forename: Kayvan
authors.initials: K
authors.lastname: Shokrollahi
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Marsden
authors.forename: Iain S
authors.initials: IS
authors.lastname: Whitaker
authors.forename: William
authors.initials: W
authors.lastname: James
authors.forename: Maxwell Sc
authors.initials: MS
authors.lastname: Murison