Methyl aminolevulinate-based photodynamic therapy of Bowen´s disease: Observational study of 21 lesions

Abstract

Background: Although surgical removal is the treatment of choice in Bowen's disease (BD), there are cases in which by age, comorbidities, use of anticoagulants, location, cosmetic result, or size, it is preferable to use other alternative treatments such as cryotherapy, 5-fluorouracil cream, imiquimod 5% cream or photodynamic therapy (PDT). Efficacy of PDT in BD is supported by substantial research and clinical data. Objectives: This study aimed to evaluate the long term effectiveness of methyl aminolevulinate-PDT (MAL/PDT) on a wide range of Bowen lesions in different locations and sizes. Methods: Patients diagnosed with BD were treated in 3 sessions with a 4-week interval in between with MAL/PDT between January 2016 and January 2017 in a private clinic. Clinical response and relevant patient and tumour characteristics were analyzed during the first year after start of the PDT sessions. Results: In total, 21 BD lesions in 18 patients were included in the study. Complete regression (CR) after 3rd PDT session was 87.5% and 100% at the 6-month follow-up. Treatment was well tolerated and local adverse reactions were very scarce. No recurrence was observed at 12-month follow-up. Cosmetic outcome at 12 months was good or excellent in 100% of patients. Conclusions: MAL/PDT is an effective, non invasive and safe treatment modality for BD with excellent cosmesis.

Efficacy of Photodynamic Therapy for the Treatment of Bowen’s Disease: A Meta-Analysis of Randomized Controlled Trials

“…Furthermore, in the study comparing ACL-PDT and AFL-PDT, AFL-PDT was considered less painful, but the reason remained unknown [23]. Finally, as we discussed above, all treatment-related AEs were moderate or mild, and the durations were short, ranging from days to weeks [4].…”

“…The lesions usually appear as slow-growing, scaly, reddish patches or plaques with well-defined irregular edges [3]. Although the disease is not life-threatening, there is still a 3–5% risk of BD lesions developing into invasive SCC [4, 5]. In addition, one-third of the invasive SCCs developed from BD may metastasize [6].…”

Bowen's Disease: Literature Review

“…Также имеется сообщение об успешном применении геля, содержащего ингенол мебутат, для лечения очагов болезни Боуэна небольших размеров [46]. Фотодинамическая терапия являе тся хорошо зарекомендовавшим себя терапевтическим вариантом при актинических кератозах, базальноклеточном раке (узловой вариант) и при лечении болезни Боуэна [47][48][49][50]. Данная терапия основана на сочетании света и светочувствительных веществ (порфиринов) в присутствии кислорода, молекулам которого передается энергия фотонов, поглощенная порфиринами [51].…”

Squamous Cell Carcinoma in Situ of the Nail Unit: Current Evidence and Recommendations for Patient Centered Treatment

“…Several randomized control trials have also demonstrated superiority of combined MAL-PDT to cryotherapy and ALA-PDT to topical 5-FU, but these results are inconsistent and long-term clearance rates are similar. 14,39 Multiple case reports have demonstrated long-term success of peri-and subungual SCCis treated with PDT. Each of the documented subungual cases included at least partial nail plate avulsion, all of which re-grew.…”

“…Several randomized control trials have also demonstrated superiority of combined MAL-PDT to cryotherapy and ALA-PDT to topical 5-FU, but these results are inconsistent and long-term clearance rates are similar. 14,39…”