Abstract
For solar keratoses and superficial basal cell carcinoma, loose crusts and debris are removed with a small curette or blade, and the lesion surface is roughened by gentle scraping. Damage to the surrounding normal skin should be avoided. For nodular BCC, the epidermal keratin layer (which can impede absorption) is removed with a scalpel blade or curette, and the exposed tumour material gently removed. Local anaesthesia is rarely used, but if required it should be used without adrenaline. Methyl aminolaevulinate (MAL) PDT treatment relies on the production of reactive oxygen species; adrenaline will cause vasoconstriction, leading to less tissue oxygenation. If bleeding occurs during lesion preparation, light pressure should be applied. Treatment can be continued once bleeding stops.
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