Methylaminolaevulinate-based photodynamic therapy of Bowen's disease and squamous cell carcinoma

P. G. Calzavara-Pinton, M. Venturini, R. Sala, R. Capezzera, G. Parrinello, C. Specchia, C. Zane

Research output: Contribution to journalArticle

Abstract

Background: Photodynamic therapy (PDT) with methylaminolaevulinate (MAL) is an approved noninvasive treatment option for actinic keratosis and Bowen's disease (BD), two precursors of invasive squamous cell carcinoma (SCC). Objectives: To assess efficacy, prognostic features, tolerability and cosmetic outcome of MAL-PDT for the treatment of BD and SCC. Methods: In total, 112 biopsy-proven lesions of BD and SCC in 55 subjects were treated in an outpatient setting. MAL cream (160 mg g-1) was applied for 3 h prior to illumination with a light-emitting diode source (wavelength range 635 ± 18 nm; light dose 37 J cm-2). A second MAL-PDT session was given 7 days later. Complete response rate at 3 months after the last treatment, recurrence rate at the 24-month follow-up, and cosmetic outcome were recorded. Results: The overall complete response rates were 73.2% at 3 months and 53.6% at 2 years. Clinical thickness, atypia and lesion depth were significant predictors of the response at 3 months when using a univariate analysis (P <0.001). A multivariate logistic regression model, with robust variance estimation, showed that cell atypia was the only statistically significant independent predictor of the treatment outcome at 3 months. Conclusions: MAL-PDT may represent a valuable, effective and well tolerated treatment option with good cosmetic outcome for superficial, well-differentiated (Broders' scores I and II) BD and microinvasive SCC. In contrast, its use for superficial SCCs with a microinvasive histological pattern and for nodular, invasive lesions, particularly if poorly differentiated keratinocytes are present (Broders' scores III and IV), should be avoided.

Original languageEnglish
Pages (from-to)137-144
Number of pages8
JournalBritish Journal of Dermatology
Volume159
Issue number1
DOIs
Publication statusPublished - Jul 2008

Keywords

  • Bowen's disease
  • Clinical trial
  • Cosmetic outcome
  • Photodynamic therapy
  • Squamous cell carcinoma
  • Topical methylaminolaevulinate

ASJC Scopus subject areas

  • Dermatology

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