Photodynamic therapy for basal cell carcinoma: clinical and pathological determinants of response

Abstract

Optimization of PDT procedure for BCC requires a careful selection of the lesions. In particular, superficial BCCs, preferentially located on the trunk, show the best therapeutic response.

Six Years of Experience in Photodynamic Therapy for Basal Cell Carcinoma: Results and Fluorescence Diagnosis from 191 Lesions

“…This fact was already noted in another large retrospective study [9] where a complete response rate of 82% was found for sBCC and 33% for nBCC ( P < 0.000). Together these findings suggest that nBCC is not a good indication for PDT and, as recommended in their treatment guidelines, and surgery continues to be the gold standard for treatment [8].…”

“…The level of recommendation in sBCC treatment guidelines is A with a level of evidence of I and B for nBCC with a level of evidence of I (surgery continues to be the gold standard for nBCC) [8]. However, since its approval, few large retrospective studies that study the results of its daily use and on fluorescence diagnosis have been published [9–11]. These studies, though having less statistical power than the clinical trials, reveal new aspects of PDT on BCC by describing what happens in routine clinical practice.…”

Tumor thickness and adnexal extension of superficial basal cell carcinoma (sBCC) as determinants of treatment failure for methylaminolevulinate (MAL)-photodynamic therapy (PDT), imiquimod, and 5-fluorouracil (FU)

“…A few previous PDT studies have reported on tumor thickness as a histologic determinant of treatment failure in BCC. [8][9][10][11][12] However, results were contradictory, possibly because of the fact that inclusion was not restricted to sBCC subtypes. Only 1 study focused solely on sBCC and showed that after treatment with imiquimod a tumor with a thickness more than 0.4 mm was significantly more likely to reoccur than a thinner tumor.…”

Thickness of superficial basal cell carcinoma (sBCC) predicts imiquimod efficacy: a proposal for a thickness-based definition of sBCC

“…Studies of PDT have noted lower response rates and higher rates of treatment failure in thicker BCCs (> 0Á5 mm to > 2 mm). [29][30][31][32][33] A commonly cited cut-off is 1 mm. 30,33 One such study specifically noted response more closely associated with depth than subtype.…”