The application of Levulan®-based photodynamic therapy with imiquimod in the treatment of recurrent basal cell carcinoma

Abstract

SummaryBackgroundCommon skin tumors like basal- and squamous-cell carcinoma present a serious problem in modern medicine. Exposure to ultraviolet solar radiation is the main cause of these lesions. Since application of Aldara® and PDT separately is well documented, we decided to use both methods together.The aim of our study was to evaluate the effectiveness of local photodynamic therapy supplemented with topical application of Aldara® in basal-cell carcinoma.Material/MethodsThirty-four patients ages 50 to 68 years were enrolled to the trial and underwent PDT treatment. Each case of BCC was histopathologically confirmed. Ten patients were subjected to local Levulan®-PDT and placebo (Eucerin as vehicle cream), and 24 patients were subjected to Levulan®-PDT and imiquimod. Photodynamic diagnosis (PDD) was used to detect and visualize suspicious foci (including cancer lesions).ResultsIn the group of patients who were treated using Levulan®-PDT and placebo, 6 patients (60%) were totally cured and 4 lesions (40%) significantly decreased in size. In the group of patients treated with Levulan®-PDT and imiquimod, 18 lesions totally disappeared (75%), 6 lesions significantly diminished, and in 1 patient small foci of previously excised BCC developed again in scar tissue 10 month after the first control examination.ConclusionsCure was achieved without any scarring and with very good cosmetic effects. Although this is the preliminary report, the presented modification of PDT seems to be reasonable and promising in treating basal-cell carcinoma.

Immunocryosurgery for Non-superficial Basal Cell Carcinoma: A Pro­spective, Open-label Phase III Study for Tumours ≤ 2 cm in Diameter

“…The combination of 2 cycles of photodynamic therapy (PDT) with pretreatment curettage has shown improved efficacy for < 2 cm diameter BCC (24). Furthermore, the use of imiquimod following treatment of BCC with PDT has significantly increased the efficacy of the treatment, to 75% at 10 months follow-up (25). Imiquimod after cryotherapy (cryoimmunotherapy), although therapeutically inferior to current "immunocryosurgery" for non-superficial BCC (16) has proved effective for the treatment of superficial BCC and Bowen's disease (26), as well as for BCC refractory to prior monomodal topical imiquimod (27).…”

Guidelines of care for the management of basal cell carcinoma

“…35,38,64,74,76,77,[80][81][82]86,87,99 Application of the photosensitizer is often preceded by light curettage of BCCs. 99 Usually a single treatment cycle is performed, but treatments may be repeated.…”

“…77,83 Post-treatment adverse events include photosensitivity and the consequent need for light avoidance and photoprotection for 48 hours, erythema, edema, tenderness, and, occasionally, crust or erosions. 81,82 As with other topical treatments for BCC, there are individual differences in patient discomfort after treatment.…”

Current Evidence and Applications of Photodynamic Therapy in Dermatology

“…73 However, combined therapy of ALA-PDT and 5% imiquimod has been suggested to achieve a 15% improvement in complete remission of nodular BCC compared with ALA-PDT alone. 74 …”