Photodynamic Therapy as an alternative to surgery in the treatment of skin cancer
You’ve been diagnosed with skin cancer and you’re scared about having to undergo surgery, so you decide to find out if there are other treatment options.
Photodynamic Therapy may be a valid option, but do you know if it is the right option to solve your problem?
I am dr.
Verónica Ruiz
Throughout my professional career I have managed to treat numerous skin lesions satisfactorily and with good cosmetic results using photodynamic therapy. In my opinion, it is a good therapeutic alternative if we select the appropriate skin lesion.
Learn about the advantages of Photodynamic Therapy
Photodynamic therapy (PhT) is a noninvasive treatment modality used primarily for the selective elimination of certain types of surfaces of skin cancer.
Its effectiveness is supported by many scientific studies and offers very good cosmetic results, causing minimal damage to the surrounding skin, since it only targets cancer cells (or neoplastic).
The use of PDT in dermatology has been increasing in recent years due to numerous studies confirming its efficacy, safety, comfort and excellent cosmetic results.
Indications and procedure of Photodynamic Therapy
Which patients are candidates for PDT?
Current indications in dermatology for the application of PDT are skin pre cancer injuries such as:
- Actinic Keratosis
- Lip Sun Damage (or actinic cheilitis)
- Superficial basal cell carcinoma
- Superficial squamous carcinoma or Bowen disease.
- Skin leishmaniosis
- Acne: This therapy works by selectively destroying the sebaceous unit responsible for the genesis and maintenance of acne.
- Facial rejuvenation: The light used is used to correct blemishes, remove fine wrinkles and tone the skin. It increases local blood circulation, stimulates collagen production, accelerates healing and stimulates lymphatic activity.
- Zoon Balanitis
- Onychomycosis
- Skin Lymphoma: Several studies demonstrate the complete/partial resolution of fungoid mycosis injuries in initial stages (I-II).
- Accelerates wound healing: This type of light significantly stimulates the formation of fibroblasts, which are the cells responsible for healing
¿What is
the procedure?
Scraping the skin lesion by removing the scabs
(in the case in which injuries treated are Actinic Keratosis). Occasionally the patient is instructed to apply exfoliating or keratolytic creams (eg: salicylic vaseline) for a few days or weeks prior to the procedure to eliminate scabs and facilitate the penetration of the photosensitizing cream.
Application of photosensitizing creme
Application of the photosensibilizing cream (in occlusion of Metvix® and non-occlusive for Ameluz® in the injury for 2h-2h 30´.
Cleaning and exposure of the are
After this time, the area is cleaned with serum and the area is exposed to a red light (630 nm) during 8-9 minutes.
Next sessions
A minimum of 2 sessions with an Interval between them of 2-3 weeks is usual required to achieve the desired effectiveness.
It is not essential that the patient is accompanied on the day performing the technique, unless they are dependent patients.
Frequently asked
questions
It is the skin area that presents significant sun damage (or actinic) accumulated for years and on which we can have clinically objective injuries such as precancerous injuries (actinic keratosis) or skin cancer already established, but in which there are also other non-visual subclinical injuries that could degenerate in the short-medium term, so that PhT would be an adequate therapeutic and preventive modality in this area.
“The application of regular TFD cycles represents a good treatment option for the cancer field and there are even studies that highlight a preventive role of therapy.”
- Burning sensation or pain, during the exposure to light.It is the most common side effect. These discomforts usually begin a few minutes after the application of the light and usually disappear shortly after its completion. It must be said that its appearance depends on the area in question: the scalp, nose or atrial wards that are areas where patients refer more pain, but there is no doubt that there is great individual variability.
Treatment: Methods to relieve this pain include applying fans and cold water during lighting, regular lighting interruption, administering any oral pain and applying local anesthesia prior to lighting; EMLA application is contraindicated because it could interfere with photosensitizer (Metvix®).
- Redness (or erythema) and local swelling: they are also common and last between 24-48 hours after treatment. The appearance of blisters, intense necrosis or ulceration are exceptional. Treatment: Hydration or application of a low potency topical corticosteroid.
- Local skin photosensitivity also exists, only in the area of application of the cream and lasts for 24-48 hours, so it is recommended that patients have the affected area covered with a dressing during that time.
- Skin hypo-hyperpigmentation in the medium-long term
On many occasions, it is necessary to perform 2-3 PDT sessions with intervals of 2-4 weeks between them, since a single session is generally not enough to completely eliminate the skin lesion.