Results suggested that apoptosis is involved in tumour cell death after PDT in patients with AK, and that it occurs within 1 day after PDT.

Photodynamic therapy (PDT), which employs a combination of a tumor-localizing photosensitizer and visible light, has been used in the treatment of extramammary Paget's disease (EMPD). Two patients with EMPD were treated with PDT using 5-aminolevulinic acid (ALA). Histologically, in both cases, Paget's cells were present within the epidermis. Case 1 was a 92-year-old male who underwent total extirpation for treatment of EMPD. Two topical ALA-PDT treatments were applied to parts of the lesions at a total dose of 200J/cm2. Case 2 was a 73-year-old female, whose lesions in the right labia majora were treated with 3 topical ALA-PDT sessions at a total dose of 300 J/cm2. Clinical findings after the irradiation showed improvement in both patients, and elimination of tumor cells in the epidermis was confirmed histologically. Case 1 had no recurrence in the irradiation field at three months after PDT. Case 2 had a recurrence only in the periphery parts of the lesions at two months after PDT, but the periphery lesions remitted with two more PDT treatments. Topical ALA-PDT is an effective treatment for EMPD with tumor cells within the epidermis. It is noninvasive and achieves a cosmetically excellent outcome, especially in elderly patients and those in poor general condition.

Background: Photodynamic therapy (PDT) is a novel noninvasive dermatological therapy that has been used together with topical application of 5-aminolevulinic acid (ALA) to treat non-melanoma skin cancers and non-oncological diseases. Multicenter randomized controlled studies have now demonstrated high efficacy of PDT in actinic keratoses and Bowen's disease. However, it seemed possible that topical PDT would be less effective in brown-skinned individuals, including Japanese, than in white Caucasians. Aim: Establish a standard treatment modality of ALA-PDT in Japanese patients in order to evaluate and improve the effects of PDT in the treatment of actinic keratoses and Bowen's disease. Materials: A total of 152 lesions of actinic keratoses and 48 lesions of Bowen's disease in Japanese patients were treated with ALA-PDT using our protocol. Methods: Lesions were treated in three sessions, one week apart, with 50J/cm 2 irradiation in each session for a total dose of 150J/cm 2 in actinic keratoses, and 100J/cm 2 irradiation in each session for a total dose of 300J/cm 2 in Bowen's disease. Results: We achieved overall complete response rates of 81.6% (124/152 lesions) in total actinic keratoses, especially 87.2% (109/125 lesions) for lesions on the face/scalp, and 75.0 % (36/48 lesions) in Bowen's disease, especially 88.9% (8/9 lesions) for lesions on the trunk. We have also treated non-oncological diseases, such as recalcitrant warts, cutaneous sarcoidosis and other diseases with ALA-PDT with satisfactory outcomes. Conclusions: The ALA-PDT according to our protocol was very successful in the treatment of Japanese patients with actinic keratoses or Bowen's disease. A therapeutical benefit of PDT is evident in inflammatory and other dermatoses.

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Combined use of ALA and PUVA using 8-MOP and UVA lamps, which are widespread in Japan, had a strong anti-tumor effect in vitro. Combined treatment with ALA-PDT and PUVA using a UVA lamp appears to have a strong treatment effect.