Rapid Wound Re-epithelialization and Basal Cell Carcinoma Clearance After MohsMicrographic Surgery With Postoperative Photodynamic Therapy

Background: Methyl aminolevulinic acid photodynamic therapy (MAL-PDT) has antitumor activity and may promote wound healing. Superficial and nodular basal cell carcinomas (BCCs) have been successfully treated with MAL-PDT in prior reports. In vitro and animal studies have shown more rapid re-epithelialization and decreased myofibroblast response after treatment thus suggesting that PDT may play a possible role in promotion of wound healing.

Objectives: To describe a novel case of a large multifocal BCC treated with postoperative PDT that showed results of tumor clearance and rapid re-epithelialization and to review the relevant literature.

Case Report: A patient presented for Mohs micrographic surgery (MMS) after recent biopsy revealed recurrent BCC. Mohs micrographic surgery was performed, where after six stages were taken, approximately 50% of the peripheral margins of the tumor remained positive for superficial BCC. Given the large size of the wound defect (12.5 cm x 9 cm) and superficial nature of the persistent tumor, the authors opted to treat the patient with adjuvant MAL-PDT in lieu of pursuing additional stages with MMS. The patient returned the following day for adjuvant therapy with MAL-PDT. Two consecutive treatments one week apart were given as an adjunctive treatment course for persistent BCC. At follow-up four weeks after the PDT treatment, the defect had fully reepithelialized. In the authors’ clinical practice, an untreated wound of this size typically heals in 10–12 weeks. The patient has been seen in six months of follow-up to date. Review of the literature relevant to use of MAL-PDT in treatment of basal cell carcinoma and literature describing effects of PDT on wound healing was performed.

Conclusion: MAL-PDT may be an effective adjuvant tool against large multifocal BCCs for which surgery has not resulted in clearance. Treatment with PDT resulted in rapid re-epithelialization of the surgical wound in this case. This observation is supported by prior in vitro studies and in vivo animal experiments demonstrating more rapid re-epithelialization of wounds and decreased scarring response after PDT.