Photodynamic therapy with methylaminolevulinate as a valuable treatment option for unilesional cutaneous T‐cell lymphoma

Abstract

Mycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma (CTCL). Unilesional MF is characterized by a limited involvement of the skin and a chronical, though indolent course. If lesions are refractory to topical steroids, therapies such as localized chemotherapy, photochemotherapy and radiotherapy are available. However, they have several acute and chronic side-effects and toxicity may accumulate if repeated and protracted treatment cycles are delivered to refractory or relapsing lesions. The present study aims to assess the efficacy of photodynamic therapy (PDT) with topical methylaminolevulinate (MAL) in the treatment of unilesional MF. Five patients were enrolled who had unilesional MF that did not respond to treatment with topical steroids, localized psoralen and UVA therapy or UVA1 phototherapies. A 20% MAL (Metvix cream) cream was applied under occlusive dressing for 3 h. Soon afterwards, skin was irradiated with 37.5 J/cm(2) of red light (635+/-18 nm) delivered by an Aktilite CL128 lamp (PhotoCure ASA) with an irradiance of 86 W/cm(2) at skin level. PDT was repeated once weekly until complete clearing of the lesions was obtained, or, in the case of partial clearing, the therapy was interupted when three successive treatments provided no further improvement. All patients underwent a skin biopsy before and after PDT. A complete remission was observed in four patients and a partial improvement in one. The median number of treatments was six (range 1-9). In no cases was recurrence seen at follow-up (ranging from 12 to 34 months). Treatments were well tolerated and local anesthesia was never requested. In conclusion, here, PDT was seen to be an effective and well-tolerated treatment option for unilesional MF.