Bowen’s disease, solar keratoses and superficial basal cell carcinomas treated by photodynamic therapy using a large-field incoherent light source

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Abstract
Background Photodynamic therapy (PDT) has not yet been demonstrated to be superior to conventional treatment in the treatment of superficial skin cancers and premalignant skin conditions. A limitation for PDT is the absence to date of a light source suitable for the treatment of larger lesions or ‘field changes’ where several lesions are present on one anatomical site. Objectives To investigate the safety and efficacy of a large field light source, the Waldmann PDT 1200, in the treatment of Bowen’s disease (BD), superficial basal cell carcinomas (BCCs) and solar keratoses (SKs). Methods After application of 5‐aminolaevulinic acid for 4–6 h, each lesion was irradiated with 105 J cm−2 of incoherent red light centred on 640 nm. Eighty‐eight patients with 239 lesions were recruited. Results Within two treatments, 88% of BD lesions, 95% of BCCs and 99% of SKs showed complete clinical clearance. At 12 months the complete response rates were 69% for BD, 82% for BCC and 72% for SK. Conclusions This study confirms that PDT is a useful treatment and that selected superficial BCCs and SKs respond well to PDT. The PDT 1200 light source proved capable of treating multiple lesions amounting to a ‘field change’ and also lesions up to 10 cm in diameter within an acceptable treatment time. Thus far, PDT has failed to become established as a routine treatment for small premalignant and malignant skin lesions as it has not proved superior to simple cheaper conventional therapies such as cryotherapy, curettage and cautery, topical chemotherapy with 5‐fluorouracil, or surgery. However, PDT has become established as a treatment for selected cases in some centres. This study suggests a role for PDT in the treatment of large premalignancies, superficial BCCs and field change where existing treatments may be problematic.

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