Ocular preservation through limited tumor excision combined with ALA-PDT in patients with periocular basal cell carcinoma.

Abstract

In recent years, photodynamic therapy (PDT) has emerged as a successful technique for treating early non-melanoma skin cancers compared with traditional methods such as surgical operation, chemotherapy, radiotherapy, and immunity treatment, etc. PDT offers excellent aesthetic results and skin function preservation effects, especially so for tumor in difficult-to-treat areas. The purpose of this article was to study the anti-tumor effect of ALA-PDT combined with limited excision in periocular basal cell carcinoma (BCC) and its role in improving the effect of the operation. In our study, 8 patients with periocular basal cell carcinoma were treated with topical aminolevulinic acid photodynamic therapy (ALA-PDT) combined with surgery. After removal of tumor mainly with normal tissue saved, each tumor region was irradiated with 177 J/cm2 using a 635-nm laser for 15 min. A total of 3 times of assisted ALA-PDT was applied during and after operation. BCC was confirmed by pathological examination and the structure of tumor tissues was observed by transmission electron microscopy. Transmission electron microscopy showed that PDT had inhibitory effects on the growth of BCC by causing necrosis of tumor cells. There was no recurrence in the follow-up of 2.8 years (range, 0.6-5 years). The patients with infiltrative orbital BCC were able to complete the treatment protocol with good cosmetic results and no significant side effects. PDT in combination with limited surgery is a safe, effective and minimally-invasive approach for treating orbital BCC. Topical PDT during and after operation can reduce the excision range of the tumor lesions. Therefore, PDT may play a positive role in the treatment of periocular basal cell carcinoma.