Non-Invasive Treatment of Basal Cell Carcinoma: Photodynamic Therapy Following Curettage

May 2023 | Volume 22 | Issue 5 | 481 | Copyright © May 2023


Published online April 28, 2023

doi:10.36849/JDD.7133 Lultschik SDJ, Tran JVH, Sapra S, et al. Non-Invasive treatment of basal cell carcinoma: photodynamic therapy following curettage. J Drugs Dermatol. 2023;22(5):481-485. doi:10.36849/JDD.7133

Shantel DJ Lultschik BHSc, Jennifer VH Tran BSc, Sheetal Sapra MD, Kunal Sharma BSc, Kevin Dong HBA

Institute of Cosmetic and Laser Surgery, Oakville, Ontario, Canada

Abstract
Background: To investigate the effectiveness, safety, patient satisfaction, and cosmetic outcome of Methyl Aminolevulinate-Photodynamic Therapy (MAL-PDT) following curettage in order to make recommendations for its use in dermatology practices.
Methods: A retrospective chart review of patients who received MAL-PDT following curettage for the indication of basal cell carcinoma (BCC) between 2009 and 2016 at a single private clinic in Ontario, Canada. Two hundred and seventy-eight patients with 352 BCC lesions were included, consisting of 44.2% males (n=123) and 55.8% females (n=155) with a mean age of 57.24 years. The primary outcome measurement consisted of the cure rate. Secondary outcome measurements included side effects, patient satisfaction, and cosmetic outcome, as reported in the medical charts.
Results: The overall cure rate was 90.3% (n=318). After controlling for age, sex, and lesion type, nasal lesions were approximately 2.82 (95% CI: 1.24-6.40, P=0.01) times more likely to experience a recurrence. 18.3% of patients (n=51) reported side effects, the most common being burning (n=19). Of those who expressed satisfaction, 100% (n=25) reported being happy. Of lesions with cosmetic data, 90.3% displayed a good response (n=149).
Conclusion: MAL-PDT following curettage is an effective and safe treatment option for BCC lesions with a good cosmetic outcome and suggested high patient satisfaction.

J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.7133

Lultschik SDJ, Tran JVH, Sapra S, et al. Non-Invasive treatment of basal cell carcinoma: photodynamic therapy following curettage. J Drugs Dermatol. 2023;22(5):481-485. doi:10.36849/JDD.7133

INTRODUCTION

Basal cell carcinoma (BCC) is the most common form of skin cancer in North America.1,2 Although there is a 5-year survival rate of 100% and metastasis is rare (incidence of 0.0028%-0.55%), BCCs cause significant morbidity as well as a burden on healthcare services.2-4 High cure rates with low chances of recurrence are seen with early detection and treatment.2,3 There are 2 categories of treatment for BCC: surgical and non-surgical. Surgical options include electrodessication and curettage (ED&C), cryosurgery, surgical excision, and Mohs micrographic surgery (MMS).1-3 Non-surgical options include photodynamic therapy (PDT), radiation therapy, and topical therapies such as imiquimod or fluorouracil creams.1-3 The goal of treating BCCs is to achieve a complete removal of the lesion while preserving cosmesis.5

The treatment standards in Canada consist of surgical excision or ED&C for low-risk BCC and MMS for high-risk BCC.1 Similarly, surgical excision and MMS are the treatment standards in the United States (US).6-8 Topical PDT provides a high level of cosmesis difficult to accomplish with surgical techniques.3 PDT relies on a photosensitizer, such as methyl aminolevulinate (MAL) that promotes cell death without affecting the surrounding tissue.9 MAL-PDT is marketed as Metvix® (Galderma & Photocure ASA), which contains 16.8% MAL and is indicated for treatment of both BCC and actinic keratosis.9 Canadian and American guidelines suggest the use of PDT for low-risk superficial BCCs.1,6

MAL-PDT is well tolerated, with the most common side effects being local reactions consisting of stinging pain, burning, pruritus, erythema, and edema that typically resolve on the day of treatment.1,10 A systematic review evaluating treatment options found the average recurrence rate of MAL-PDT to be 17.8% (95% CI: 9.1-31.8) for primary BCC.11 Another review found that MAL-PDT achieved a complete remission in 91% of superficial BCCs.12 The average 5-year overall cure rate for MAL-PDT is 87% for primary superficial lesions.3 Although a slightly higher recurrence rate is seen, MAL-PDT treatment is preferred over surgery due to a significantly better cosmetic outcome.12 Weston and Fitzgerald revealed that patients place the most importance on risk of scarring and cosmetic outcome, whereas lesion response had no significant impact when deciding between MAL-PDT or surgical treatment.13
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