Combination of Er:YAG laser and photodynamic therapy in the treatment of nodular basal cell carcinoma

Abstract

Backgrounds and Objectives: Photodynamic therapy (PDT), via topical aminolevulinic acid (ALA) is an effective treatment for basal cell carcinomas not exceeding a depth of 2 mm. This limits the treatment of basal cell carcinoma (non-melanoma skin cancer) to superficial forms and nodular therapy (only in aesthetically desired locations). This paper addresses the effectiveness of reducing tumor mass via initial Er:YAG laser ablation to depths that are therapeutically responsive to PDT with ALA. Study Design/Materials and Methods: This study compared three methods for the treatment of recurring nodular basal cell carcinomas (r nBCC). Method A utilized PDT with topical application of ALA methyl ester, method B with solitary Er:YAG laser ablation, and method C combined Er:YAG laser ablation reducing tumor size below 2 mm (method B) with subsequent ALA methyl ester PDT (method A). All three methods were used to treat to each patient, all subjects presenting with three or more basal cell carcinomas in order to eliminate differences in patient responsiveness to treatment. Patients were monitored and interviewed at 3, 6, and 12 month intervals to examine the progress of tumor elimination, aesthetic results as well as the patient's preference of treatment method. In all, 286 patients were treated, of whom 194 were checked at the prescribed intervals and then evaluated. Results: Statistically, the combination therapy demonstrated the most effective treatment at all time intervals, with a final efficacy of 98.97% versus 94.85% (PDT only) and 91.75% (Er:YAG laser only). The combined method also provided the best aesthetic results (scale: 1-best; 4-worst) of 1.23 AE 1.23, compared to 1.67 AE 0.76 (PDT only) and 1.83 AE 0.95 (Er:YAG laser only). Conclusions: Although 67% patients preferred solitary Er:YAG laser treatment over the PDT method (20%) and the combined treatment (13%), because of the simplicity of the treatment, the combination therapy has proven to be both clinically and aesthetically superior. Solitary Er:YAG laser ablation will remain however a fast, effective, and economical treatment alternative for simple manifestations of superficial basal cell carcinoma and has replaced PDT for uncomplicated cases at our facility. The combination of Er:YAG laser ablation and ALA-PDT aspires to be therapy of choice for BCC. Lasers Surg. Med. 40:153-158, 2008. ß

Guidelines of care for the management of basal cell carcinoma

“…Longterm data regarding the safety and effectiveness of pulsed dye or Er:YAG lasers for treatment of BCC are lacking. 74,93,104 …”

Confocal microscopy to guide Erbium:yttrium aluminum garnet laser ablation of basal cell carcinoma: anex vivofeasibility study

“…[5][6][7][8] Laser ablation, e.g., is effective for treating superficial and nodular BCCs. [9][10][11] The treatment is relatively quick and convenient to perform in a single patient visit, and is minimally invasive, with finely controlled micrometer-level removal of tissue, reduced bleeding, scarring and infection, quicker recovery, and better cosmetic outcome. However, efficacy and reliability tend to be variable because the tissue is vaporized such that none is available for subsequent histopathological examination for residual BCC.…”

Lazerin Dermatolojide Diğer Kullanım Alanları

“…Bazal hücreli karsinomu olan olgularda fotodinamik terapi ile birlikte Er:YAG lazer uygulaması hem etkili, güvenilir hem de kozmetik sonuçları başarılı bir yöntem olduğu rapor edilmiştir 37 . Moskalik ve ark., yaptıkları bir çalışmada ise Nd:YAG lazeri yüz bölgesinde toplam 3624 cilt kanserinde (3346 T (1-2)N(0)M(0) bazal hücreli cilt kanserinde, 188 sınırlı bazal hücreli kanserinde ve 90 skuamöz hücreli kanseri) uygulamışlar ve yüz bölgesindeki cilt kanserlerinden evre T(1-2)N(0)M(0) olan kanserler için etkili ve kozmetik sonuçları olumlu olarak rapor etmişlerdir.…”