Abstract
Between January 1991 and December 1992 a phase I trial of superficial photodynamic therapy (PDT) using topical application of 5-aminolaevulinic acid (ALA) was undertaken to treat Bowen's disease, superficial basal cell carcinomas (BCCs) and metastatic skin secondaries from breast (adenocarcinoma) or pinna (squamous cell carcinoma). Promising results were obtained with 36 areas of Bowen's disease, with a complete response rate of 89% at a median follow-up of 18 months. The treatment of BCCs was less successful, with 50% complete responses in 16 lesions at a median follow-up of 17 months. Metastatic nodules responded poorly. The treatment was well tolerated and discomfort during light irradiation could be reduced by prior application of 'Emla' cream. Lesions wept for 1-2 weeks following treatment and healed over a period of approximately 2 months. For large areas of Bowen's disease, particularly in anatomically difficult areas and in elderly patients, PDT using ALA may constitute a single simple alternative outpatient treatment to existing therapies. Further work is required to improve the results with BCCs.
Highlights
This paper reports our work with superficial primary and secondary skin cancer using aminolaevulinic acid (ALA) cream and 630 nm light
A CR rate of 88% (14/16 lesions) was seen at 2 months, falling to 50% (8/16 lesions) at a median follow-up of 17 months
photodynamic therapy (PDT) FOR SUPERFICIAL SKIN CANCER 607 a Primary skin cancer may be treated by a variety of techniques (White, 1992)
Summary
Local ethical committee approval was obtained for these studies, as was individual consent. 0.05 g of cream was applied per cm of skin, and the lesion covered with a gauze dressing. Between 2 and 4 h after application of the ALA cream, 5% Emla cream (lignocaine base 2.5% and prilocaine 2.5%, Astra Pharmaceuticals) was applied to the lesion with an occlusive dressing and gauze covering. Half of the lesions were examined for fluorescence at time intervals of 3-6 h after administering the cream. This was done in an entirely qualitative manner by directing an ultraviolet dental probe at the lesion and looking for the red fluorescence of PpIX by eye
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