Treatment of actinic cheilitis using photodynamic therapy: report of three cases

Abstract

Actinic cheilitis is a common disease mostly of the lower lip. While actinic cheilitis is usually classified as a pre-cancerous lesion, some authors describe this disease as in situ squamous cell carcinoma (SCC). Among several treatment options, the most common is surgical excision, followed by cryotherapy, CO2-laser ablation and topical treatment with 5-fluorouracil, trichloroacetic acid or retinoids (Dufrene and Curlin 1997). Recently, photodynamic therapy (PDT) has been introduced as a therapeutical option for epithelial skin tumors, actinic keratoses and superficial basal cell carcinomas (Szeimies and Landthaler 2002). Here we report three patients suffering from actinic cheilitis treated by PDT using the new photosensitizing agent methyl aminolevulinate (Methyl-5-amino-4-oxopenthanoate, MAOP, Metvix™). Before treatment, Metvix™ Creme containing 160mg/g of methyl aminolevulinate (Foley 2003) was applied using an occlusive plastic wrap. After three hours, these occlusive dressings were removed and the treated skin was exposed to red light exposure (Actilite® CL128, Galderma, Düsseldorf, Germany) for 7 minutes and 50 seconds. This procedure was repeated one week after the first PDT. In order to determine the degree of pain associated with this procedure, the patients were asked to rate the pain experienced on a scale from 0 (no pain) to 10 (obliterative pain) according to Grappengiesser et al (2002). The clinical and cosmetic results in all patients were excellent. Because actinic cheilitis may eventually transform into invasive SCC, early treatment is highly recommended. Surgical excision (vermillionectomy) of the affected skin is the established standard therapy. The effectiveness of PDT for the treatment of actinic keratoses and superficial basal cell carcinomas (BCC) with complete remission in 80 to 90% of all cases is documented in several clinical studies. For the last two years, MAOP (Metvix® Cream) is approved for PDT in Germany for the treatment of actinic keratoses and BCC. To the best of our knowledge, only one report concerning the treatment of actinic cheilitis using PDT has been published before. In 1996, Stender and Wulf treated three patients with 5-aminolevulinic acid and non-coherent light. During a monitoring period of up to 12 months no further relapse was observed. We consider PDT an appropriate alternative treatment option for actinic cheilitis particularly when surgical treatment is difficult, e.g. because of accompanying health conditions. However, based on the lack of reports concerning the long-term outcome of this treatment, the rate of recurrences from actinic cheilitis following PDT treatment compared to conventional vermillionectomy remains to be investigated in larger patient cohorts.