Facial Basal Cell Carcinomas Recurring after Photodynamic Therapy: A Retrospective Analysis of Histological Subtypes

Abstract

Background: Photodynamic therapy (PDT) is an established treatment for basal cell carcinomas (BCCs). Although recurrences are sometime observed, their histological patterns have never been specifically studied or compared with the one of the initial tumor. Objective: To compare the histopathological aggressiveness of BCCs recurring after PDT with that of the primary tumors. Methods: The study population included 12 patients with 16 post PDT recurrent BCCs. Outcome measures were proportion of histologically aggressive subtypes in BCC recurrences vs. primary tumor. Results: 62.5% of recurrent BCCs displayed a transition from a non-aggressive to an aggressive subtype. Conclusions: Post PDT recurrences appear to display an increased histological aggressiveness, although the latter may reflect the natural course of tumor progression. Despite the presence of potential biases, our study raises the possibility that PDT favors the selection of more aggressive tumor cells. Better systematic large-scale follow-up studies are required to assess the exact frequency and histological types of BCC recurrences after PDT.

Photodynamic Therapy and Skin Cancer

“…PDT is an established treatment for superficial and nodular types of BCC, but is not indicated for the more aggressive or infiltrating types [75]. Response rates of PDT in the existing literature vary between 70 and 90%, which may depend on the kind of tumors and the exact performance of PDT [76,77].…”

“…More aggressive types of BCC, which often occur on the face, show a greater frequency of recurrence, possibly due to genetic mutations resulting to resistance to apoptosis [75].…”

Diagnosis and management of nonmelanoma skin cancer

“…In nodular BCC, there is variation in outcome and it is not indicated for the more aggressive basisquamous, morphoeic or infiltrating subtypes of BCC or for SCC. 30 …”

Facial skin cancers: general information and an overview of treatment methods

“…Low efficacy, relapse is characterized by higher histological malignancy [48]. Surgical treatment of non-melanoma skin facial tumors with local art, depending on the location.…”