Ultrasound guided ablative-laser assisted photodynamic therapy of basal cell carcinoma (US-aL-PDT).
OBJECTIVE
With proper noninvasive ultrasound measurement of tumor depth, case selection for laser pre-ablation followed by PDT is possible. This combination of methods provides a less invasive approach to the treatment of BCC.


BACKGROUND
Basal cell carcinoma (BCC) primarily affects the face, and, therefore, radical excision is problematic because of the possibility of poor aesthetic outcomes. Photodynamic therapy (PDT) offers an advantage in aesthetic outcomes, but topical PDT is only effective for tumors with a depth up to 2 mm.


METHODS
Seventy-five histologically verified BCCs from 67 patients were selected and divided into three therapeutic groups based on the tumor depth, which was determined by 20 MHz skin ultrasound. The three groups were: A/<2 mm (PDT), B/ 2-3 mm (Er:YAG laser ablation+PDT), and C/>3 mm (diode laser ablation+PDT). The treatment consisted of laser ablation (or no ablation) followed by the application of methyl-aminolevulinate (MAL) and a 3-h treatment period using an occlusive bandage. Subsequently, illumination with 630 nm (MAL-PDT) was performed. MAL-PDT was repeated 1-3 weeks after the first treatment. A clinical evaluation was performed after 6 months.


RESULTS
A 100% clearance rate (CR) in the group with the deepest tumors was observed. In addition, a 94.7% CR occurred in the group with tumors 2-3 mm in depth, and an 81.2% CR was observed in the group with superficial tumors.


CONCLUSIONS
With proper ultrasound case selection and laser ablation before MAL-PDT, the depth of a BCC lesion is not a limiting factor for PDT, and aesthetic outcomes are very good. Therefore, ultrasound-guided ablative laser-assisted PDT of BCC can be the method of choice, particularly in aesthetically challenging cases.
Centre of Photonic Medicine, Charles University, Prague, Czech Republic. roman.smucler@lf1.cuni.cz
Roman
R
Smucler
Martin
M
Kriz
Jan
J
Lippert
Marek
M
Vlk
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives / Q000494:pharmacology; D001707:Biopsy, Needle; D002280:Basal Cell Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004954:Esthetics; D005145:Face; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography
C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid