title: Photodynamic Therapy Followed by Mohs Micrographic Surgery Compared to Mohs Micrographic Surgery Alone for the Treatment of Basal Cell Carcinoma: Results of a Pilot Single-Blinded Randomised Controlled Trial.
abstract: BACKGROUND
  Basal cell carcinoma is a common cutaneous malignant tumour. Surgical excision is the "gold standard" treatment for most subtypes, with Mohs micrographic surgery (MMS) offering the highest cure rate. Other treatment modalities used include photodynamic therapy (PDT).
  
  
  BACKGROUND
  We aimed to study the efficacy of combining MMS with PDT to see whether this would reduce the number of stages and final defect size when compared with MMS alone.
  
  
  METHODS
  Our study was a single-centre, single-blinded, randomised and controlled pilot study involving a total of 19 patients. Nine patients were randomised to pre-treatment with PDT followed by MMS of whom two withdrew; the remaining 10 patients were randomised to the MMS alone. Follow-up visits were arranged at 3 and 6 months post-surgery.
  
  
  RESULTS
  In the PDT arm, five out of the seven treated patients (71%) had their initial tumour size decreased following PDT treatment prior to MMS. The average number of stages in the PDT arm was 1.85, compared to 2.5 in the MMS arm. The average number of sections in the PDT arm was 4.2, in comparison to 5.2 in the MMS arm.
  
  
  CONCLUSIONS
  Our pilot study showed a promising but limited role for PDT as an adjunct in MMS in the treatment of selected cases of basal cell carcinomas. Larger trials, preferably multi-centred are required to further examine the role of this combination therapy.
authors.affiliation: Dermatologic Surgery and Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
authors.forename: Firas
authors.initials: F
authors.lastname: Al-Niaimi
authors.affiliation: Dermatologic Surgery and Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
authors.forename: Nisith
authors.initials: N
authors.lastname: Sheth
authors.affiliation: Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Habib A
authors.initials: HA
authors.lastname: Kurwa
authors.affiliation: Dermatologic Surgery and Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
authors.forename: Raj
authors.initials: R
authors.lastname: Mallipeddi
keywords: Basal cell carcinoma; Mohs micrographic surgery; Photodynamic therapy