Abstract
Topical photodynamic therapy has become an established therapy option for superficial non-melanoma skin cancers with a substantial evidence base. In this update the increased choice in photosensitizers and light sources are reviewed as well as novel protocols to move beyond lesional treatment and address field therapy. Daylight PDT is emerging as an alternative to conventional office/hospital-based PDT that offers the advantage of much reduced pain. Although most studies have assessed efficacy of PDT in immune-competent patients, there is accumulating evidence for topical PDT being considered an option to assist in reducing the skin cancer burden in organ transplant recipients. The fluorescence associated with photosensitizer application can help delineate lesions prior to full treatment illumination and offers a useful adjunct to treatment in patients where diagnostic uncertainty or poor lesion outline complicates clinical care. PDT may also offer significant benefit in delaying/preventing new cancer development and combined with its recognized photo-rejuvenating effects, is emerging as an effective therapy capable of clearing certain superficial skin cancers, potentially preventing new lesions as well as facilitating photo-rejuvenating effects in treated areas.
Highlights
Photodynamic therapy (PDT) involves the activation of a photosensitizing drug by visible light to produce reactive oxygen species within target cells, resulting in their destruction
PDT is widely used for the treatment of actinic keratoses (AK), squamous cell carcinoma in-situ (Bowen’s disease — SCC in-situ) as well as superficial and thin nodular basal cell carcinomas (BCC) around the world [1,2,3]
Several protocols have been assessed, often specific to the photosensitizer and light source used. Approvals for their use varies between countries depending on licence, with protocols outlined below quoting product information current at performance of this review, rather that study protocols that often evolve during the research cycle of a product: Conventional Methyl aminolevulinate (MAL)-PDT [19]: Indicated for thin, non-hyperkeratotic AK, SCC in-situ, sBCC, nBCC
Summary
Topical photodynamic therapy has become an established therapy option for superficial non-melanoma skin cancers with a substantial evidence base. In this update the increased choice in photosensitizers and light sources are reviewed as well as novel protocols to move beyond lesional treatment and address field therapy. Most studies have assessed efficacy of PDT in immune-competent patients, there is accumulating evidence for topical PDT being considered an option to assist in reducing the skin cancer burden in organ transplant recipients. Ключевые слова: 5-aminolaevulinic acid, methyl aminolaevulinate, non-melanoma skin cancer, topical photodynamic therapy
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