Photodynamic therapy for basal cell carcinoma

Summary

This is the largest systematic review to‐date which compares the treatment of basal cell carcinoma (BCC) with a treatment called photodynamic therapy (PDT) and alternative treatments. PDT is an established treatment option for low‐risk BCC.  PDT involves putting a cream on the skin and leaving it for 3 hours. Then a red light is shone on it; this often causes pain for a few minutes but few other side effects.  At least two treatment sessions are needed.  In our study we only used evidence from high quality studies (Randomised Control Trials) and only looked at studies which included treatments for low‐risk BCC types (superficial and nodular).  The main medical databases were searched to find all suitable studies. The benefits of treatments were compared, using previously‐agreed criteria. The differences between how often treatments would cure (effectiveness), how the area would look after treatment (cosmetic result), and the side‐effects, including pain, were compared at different times. Imiquimod and fluorouracil creams are applied regularly to the BCC over 4‐6 weeks. The creams cause discomfort which increases with time.  The peak pain from PDT was higher than imiquimod and fluorouracil, although the combined discomfort from imiquimod and PDT appeared similar. Cure rates between fluorouracil and PDT were comparable although rates with imiquimod were higher than PDT applied once. The cosmetic result with both creams was similar to PDT. Cryosurgery (freezing with liquid nitrogen) is a convenient quick treatment.  Cure rates were similar to PDT, although the cosmetic results were poorer. Surgical excision, where the tumour is cut out and the skin stitched, showed the highest cure rates. The cosmetic result after PDT was as good or better than other treatments. Our review showed that PDT is an effective treatment for low‐risk BCC, with excellent cosmetic results and safety.

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