Daylight-mediated photodynamic therapy of basal cell carcinomas - an explorative study

BACKGROUND: Studies have shown that daylight-photodynamic therapy (PDT) is an effective treatment of actinic keratoses, nearly pain free and more convenient for both the clinics and patients. Treatment of basal cell carcinomas (BCCs) is another main indication for PDT. OBJECTIVES: The aim of this open, uncontrolled, prospective explorative study was to evaluate the efficacy of daylight-PDT for BCCs. METHODS: Twenty-one patients with a total of 32 BCCs located in the face, scalp, chest, back and lower leg received one cycle of daylight-methyl aminolevulinate (MAL)-PDT, consisting of two treatments 1 week apart. After sunscreen application and lesion preparation, MAL was applied and patients exposed themselves to daylight for 2½ h. Daylight exposure was monitored with a wrist-borne dosimeter. RESULTS: At 3-month follow-up, complete response was seen in 30 lesions (94%) and in 19 patients (90%). At 12-month follow-up, six lesions had recurred resulting in a total recurrence rate of 21% (6/29) as one lesion was lost to follow-up. Twelve months after daylight-PDT, 74% (23/31) of the treated lesions showed complete response. During each treatment, the mean effective light dose was 10.8 J/cm(2) during an average of 152 min of daylight exposure. Treatment was pain free with good or excellent cosmesis. CONCLUSIONS: In conclusion, daylight-PDT proved to be as effective as conventional PDT in the treatment of BCCs in this explorative clinical study. Daylight-PDT was pain free and more convenient for both clinicians and patients. The cosmetic outcome was good or excellent. Larger studies need to confirm the findings of this study.