Abstract
Non-melanoma skin cancer (NMSC) is the most common malignancy among the Caucasian population. Photodynamic therapy (PDT) is gaining popularity for the treatment of basal cell carcinoma (BCC), Bowen’s disease (BD) and actinic keratosis (AK). A topical or systemic exogenous photosensitiser, results in selective uptake by malignant cells. Protoporphyrin IX (PpIX) is produced then activated by the introduction of a light source. Daylight-mediated MAL (methyl aminolaevulinate) PDT for AKs has the advantage of decreased pain and better patient tolerance. PDT is an effective treatment for superficial BCC, BD and both individual and field treatment of AKs. Excellent cosmesis can be achieved with high patient satisfaction. Variable results have been reported for nodular BCC, with improved outcomes following pretreatment and repeated PDT cycles. The more aggressive basisquamous, morphoeic infiltrating subtypes of BCC and invasive squamous cell carcinoma (SCC) are not suitable for PDT. Prevention of “field cancerization” in organ transplant recipients on long-term immunosuppression and patients with Gorlin syndrome (naevoid basal cell carcinoma syndrome) is a promising development. The optimisation of PDT techniques with improved photosensitiser delivery to target tissues, new generation photosensitisers and novel light sources may expand the future role of PDT in NMSC management.
Highlights
Non-melanoma skin cancer (NMSC) is the most common malignancy among the Caucasian population [1]
methyl aminolaevulinate (MAL) is usually applied for 3 h before exposure to the light source and aminolevulinic acid (ALA) is licensed for 14–18 h, shorter periods are often observed [5,10]
Actinic keratoses (AKs) are premalignant disorders of keratinocytes occurring on chronically sun-damaged skin
Summary
Non-melanoma skin cancer (NMSC) is the most common malignancy among the Caucasian population [1]. Surgery is the traditional mainstay of treatment, giving high cure rates with clear identification of tumour margins [3]. Photodynamic therapy (PDT) is gaining popularity for the treatment of certain types of basal cell carcinoma (BCC), Bowen’s disease (BD) and actinic keratoses (AK) [5]. PDT involves the application of an exogenous photosensitising agent, which is selectively taken up by malignant or premalignant cells [6]. The target cells convert the prodrug to protoporphyrin IX (PpIX), via the haem synthesis pathway [7]. Introduction of a light source causes activation of PpIX, formation of reactive oxygen species and cytotoxicity of malignant cells. Inflammation, secondary to PDT, induces proinflammatory cytokines, causing neutrophil migration to the treated tumour cells [8]
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