Derm News: 2007.11(3)

Optimized Photodynamic Therapy with Systemic Photosensitizer Following Debulking Technique for Nonmelanoma Skin Cancers

Dermatologic Surgery, 33(2):194-198
CACILDA S. SOUZA MD, PHD, ANA B. S. NEVES, LÍLIA A. B. FELÍCIO MD, JULIANA FERREIRA MD, CRISTINA KURACHI MD, PHD, VANDERLEI S. BAGNATO MD, PHD
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).

Objectives

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/cm2, at an intensity range of 130 to 150 mW/cm2, 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.

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