title: Treatment of Gorlin syndrome (nevoid basal cell carcinoma syndrome) with methylaminolevulinate photodynamic therapy in seven patients, including two children: interest of tumescent anesthesia for pain control in children.
abstract: OBJECTIVE
  To report our experience of methylaminolevulinate photodynamic therapy (MAL-PDT) in the treatment of multiple basal cell carcinoma (BCC) in adults and children with Gorlin syndrome (GS).
  
  
  METHODS
  Report of cases.
  
  
  METHODS
  University of Montpellier, Department of Dermatology.
  
  
  METHODS
  Seven Gorlin patients (41 superficial or nodular carcinomas), including two children.
  
  
  METHODS
  Prior superficial curettage for superficial BBCs or debulking for nodular BCCs was systematically performed. Methylaminolevulinic acid was applied topically to lesions 3 h before illumination with 635 nm red light for 10 min (37 J/cm(2)). To prevent treatment discomfort, analgesics and/or cooling by sprayed water were most often provided, and occasionally 1% lidocaine local anesthesia. A ropivacaine-lidocaine tumescent anesthesia was performed on the youngest patient.
  
  
  METHODS
  The initial response rate; tolerance, particularly in children; cosmetic outcome.
  
  
  RESULTS
  Overall clearance in patients was 60% after one session of MAL-PDT and 78% after three sessions. Resolution of the lesions was accompanied by an excellent cosmetic outcome in all patients. Treatments were well tolerated in adults with moderate pain sensation during illumination. In a child, tumescent anesthesia assured excellent tolerance in all treatment stages.
  
  
  CONCLUSIONS
  We add our experience to previous articles that consider PDT as an interesting option in the treatment of GS. To our knowledge, this study is the first report of MAL-PDT in GS children using tumescent anesthesia. Specific guidelines for adult and pediatric patients remain to be established.
authors.affiliation: Department of Dermatology, Saint-Eloi Hospital, University of Montpellier, Montpellier, France. celine-girard@chu-montpellier.fr
authors.forename: C
authors.initials: C
authors.lastname: Girard
authors.forename: A
authors.initials: A
authors.lastname: Debu
authors.forename: D
authors.initials: D
authors.lastname: Bessis
authors.forename: V
authors.initials: V
authors.lastname: Blatière
authors.forename: O
authors.initials: O
authors.lastname: Dereure
authors.forename: B
authors.initials: B
authors.lastname: Guillot
mesh_terms: D000293:Adolescent; D000328:Adult; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D000758:Anesthesia / Q000379:methods*; D001478:Basal Cell Nevus Syndrome / Q000188:drug therapy*; D002648:Child; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010778:Photochemotherapy
chemical_list: D000622:Aminolevulinic Acid; D008012:Lidocaine