Fractionated aminolevulinic acid-photodynamic therapy provides additional evidence for the use of PDT for non-melanoma skin cancer

?Background Photodynamic therapy (PDT) is an accepted treatment for superficial basal cel carcinoma (sBCC) and Bowens disease. In Rotterdam, extensive preclinical research has lead to an optimized twofold illumination scheme for aminolevulinic acid-PDT (ALA-PDT). Objective To provide additional evidence of ALA-PDT for sBCC, Bowens disease (BD), nodular BCC (nBCC) and actinic keratosis (AK) using a 2-fold illumination scheme after a single application of ALA. Methods Five hundred fifty-two lesions (430 sBCC, 20 nBCC, 32 BD, 70 AK) were treated with ALA-PDT using a twofold illumination scheme. ALA was applied topically for 4 h. Lesions were treated with two light fractions of 20 and 80 J/cm(2) separated by a 2-h dark interval. Results After a minimum follow-up of 12 months, in average follow-up of 2 years, an overall complete response of 95% was seen for all lesions. For sBCC, the complete response at 2 years was 97% (for AK 98%, for BD 84% and for nBCC 80% after 2 years). A sub-analysis of the results of lesions larger than 2 cm showed CR at 2 years of 89% for all lesions (n = 57). Cosmetic outcome was good to excellent in 95% of the treated lesions. Conclusions ALA-PDT using a twofold illumination scheme of 20 plus 80 J/cm(2) separated by a 2-h dark interval leads to high complete response rates at 2 years and can be regarded as an evidence-based treatment modality for superficial growing non-melanoma skin cancer and the (pre)malignant AK. The Rotterdam fractionated approach should be included in future guidelines.