Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obervation Letter
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter to the Editor
2009:75:5;530-531
doi: 10.4103/0378-6323.55416

Pigmented basal cell carcinomas treated with photodynamic therapy

Jose J Pereyra-Rodríguez1 , Jose J Bernabew-Wittel1 , Purificacion Gacto-Sanchez2 , Julian Conejo-Mir1
1 Department of Dermatology, Virgen del Rocío University Hospitals, Sevilla, Spain
2 Department of Plastic and Reconstructive Surgery, Virgen del Rocío University Hospitals, Sevilla, Spain

Correspondence Address:
Jose J Pereyra-Rodríguez
Department of Dermatology, Virgen del Rocío University Hospitals, Sevilla Spain. Avd/ Manuel Siurot s/n. 41013 Sevilla
Spain
How to cite this article:
Pereyra-Rodríguez JJ, Bernabew-Wittel JJ, Gacto-Sanchez P, Conejo-Mir J. Pigmented basal cell carcinomas treated with photodynamic therapy. Indian J Dermatol Venereol Leprol 2009;75:530-531
Copyright: (C)2009 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Basal cell carcinomas (BCC) are the most common malignancies among people with white skin. Overall pigmented BCCs are not very common, although its frequency can reach up to 20% of the total BCCs in people from the Mediterranean. [1] Photodynamic therapy (PDT) using methyl-aminolevulinate (MAL) is a treatment based on a phototoxic reaction that has proved to be successful for the eradication of superficial and nodular basal cell carcinoma as well as Bowen′s disease with good cosmetic results [2],[3] including large Phase III studies of MAL-PDT. [4] PDT is not recommended for pigmented BCC because it is generally thought that pigments might cause difficult light absorption into tumoral cells. [5] However, the effectiveness of PDT in pigmented BCC has not been properly studied. We report five cases of pigmented BCC treated with PDT-MAL with complete clinical response.

A 79-year-old female with multiple BCCs was treated during the earlier years in our department with cryotherapy, topical 5% imiquimod, and excisional surgery. She was referred again to us with 6 new tumoral lesions on her face [Figure - 1]. Because the patient refused surgery, cryotherapy or topical 5% imiquimod, PDT was proposed to her as a palliative treatment. After her written consent, PDT was performed. A histopathological examination confirmed five pigmented BCCs located on her right cheek and zigomatic area and 1 non-pigmented nodular BCC on her nose [Table - 1]. Before administration, 160 mg/g of MAL cream (Metvix® , Galderma) was applied to the lesions in order to facilitate access of MAL to all parts of the lesion. The extent of preparation was dependent on the nature of the lesion. Superficial lesions were debrided with a curette to remove scales and crusts. The lesion surface was scraped gently in order to increase penetration of the active agent. Intact skin covering nodular lesions was removed by shaving the lesion over the tumour margins. MAL 160 mg/g cream was applied, approximately 1 mm thick, on the lesion and 10 mm on the surrounding skin. After application of the cream, the lesion area was covered by an adhesive and occlusive dressing for 3 hours. When the occlusive dressing was removed, the remaining cream was gently cleaned off using saline. The lesione area was then illuminated using a light source Aktilite® 37 J/cm 2 . Time of exposure was automatically calculated by the light source (9 minutes per session). Lesions were covered with a light protective dressing after treatment for a full day. The treatment cycle was repeated once 1 week later. Lesion responses were evaluated clinically after 2 months. All treated lesions showed a complete clinical response. The patient refused a histological confirmation but 1 year later there were no signs of recurrence [Figure - 2].

It is well-known that the gold standard treatment for BCCs is surgery. [6] Micrographic Mohs surgery must be reserved only for certain histological subtypes.[6] However, other modalities of treatment such as cryotherapy, electrodesiccation, and curettage have been used with a wide ranges of success. Certain cases, such as large and multiple lesions located in difficult scarring areas, systemic risk factors that contraindicate surgery, and patients that refuse surgery, constitute a challenge for dermatologists. [2] The existence of pigments is classically considered one criteria of exclusion for PDT, because in those particular cases the light penetration into the skin is considerably reduced. [5] However, no scientific evidence supporting this argument was found. In our experience, pigmented BCCs treated by PDT-MAL demonstrated a high rate of complete regressions, in the same pattern of the non-pigmented lesions. We need to point out the importance of an adequate debulking prior to PDT-MAL, which is possibly the reason why it was previously not considered as an alternative treatment.

References
1.
Tiftikcioðlu YO, Karaaslan O, Aksoy HM, Aksoy B, Koçer U. Basal cell carcinoma in Turkey. J Dermatol 2006;33:91-5.
[Google Scholar]
2.
Braathen LR, Szeimies RM, Basset-Seguin N, Bissonnette R, Foley P, Pariser D, et al . Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: An international consensus. J Am Acad Dermatol 2007;56:125-43.
[Google Scholar]
3.
Horn M, Wolf P, Wulf HC, Warloe T, Fritsch C, Rhodes LE, et al . Topical methyl aminolaevulinate photodynamic therapy in patients with basal cell carcinoma prone to complications and poor cosmetic outcome with conventional treatment. Br J Dermatol 2003;149:1242-9
[Google Scholar]
4.
Basset-Seguin N, Ibbotson SH, Emtestam L, Tarstedt M, Morton C, Maroti M, et al . Topical methyl aminolaevulinate photodynamic therapy versus cryotherapy for superficial basal cell carcinoma: a 5 year randomized trial. Eur J Dermatol 2008;18:547-53.
[Google Scholar]
5.
Kaviani A, Ataie-Fashtami L, Fateh M, Sheikhbahaee N, Ghodsi M, Zand N, et al . GE. Photodynamic therapy of head and neck basal cell carcinoma according to different clinicopathologic features. Lasers Surg Med 2005;36:377-82.
[Google Scholar]
6.
Mosterd K, Krekels GA, Nieman FH, Ostertag JU, Essers BA, Dirksen CD, et al . Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: A prospective randomised controlled trial with 5-years' follow-up. Lancet Oncol 2008;9:1149-56.
[Google Scholar]

Fulltext Views
99

PDF downloads
74
Show Sections