Topical photodynamic therapy in the treatment of actinic keratoses and Bowen’s disease in transplant recipients

Dragieva, Galya; Hafner, Jürg; Dummer, Reinhard; Schmid‐Grendelmeier, Peter; Roos, Małgorzata; Prinz, Bettina; Burg, Günter; Binswanger, U; Kempf, Werner

doi:10.1097/01.tp.0000107284.04969.5c

Cited by 156 publications

(138 citation statements)

References 25 publications

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“…Of the 37 post-PDT SCC, 30 (81%) were invasive and 7 (19%) were microinvasive and, of the 48 SCC outside a PDT field, 34 (74%) were invasive and 12 (26.09%) microinvasive. However, no experimental studies have demonstrated an excess risk of developing SCC after PDT in that patient population (14,(27)(28)(29). In addition, as we observed more SCC outside the PDT field than in the PDT field, this emphasizes that our population had a higher risk of SCC development.…”

Section: Resultssupporting

confidence: 49%

Squamous Cell Carcinoma Following Photodynamic Therapy for Cutaneous Bowen’s Disease in a Series of 105 Patients

Ratour-Bigot

Chemidling²,

Montlahuc³

et al. 2016

Acta Derm Venerol

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Bowen's disease (BD) is an intra-epidermal carcinoma of the skin, which, if untreated, may progress to invasive squamous cell carcinoma (SCC) in 3-5% of cases (1). BD can occur anywhere on the skin in adults, especially in elderly people. BD usually presents as an asymptomatic circular erythematous scaly patch localized on a sunexposed area. Typically, BD has an excellent prognosis because of its slow evolution and good response to treatment. Although surgery is often the best treatment option for BD, new therapies have emerged in recent years. Alternatives to surgery, such as photodynamic therapy (PDT), cryosurgery, 5-fluorouracil and imiquimod, have been proposed for BD, especially when it is located in sensitive surgical areas (face, fingers, etc.) (1-11). PDT is also used in the treatment of actinic keratoses (AK) and superficial basal cell carcinomas. Its use in other fields of dermatology is under evaluation (12).PDT is based on the application of a photosensitizing product or its precursor, which is activated by a light source of an appropriate wavelength according to the absorption spectrum of the photosensitizer and offers sufficient penetration. Its activation causes the selective destruction of malignant cells via production of reactive oxygen species (ROS). Methyl aminolevulinate (MAL) in its hydrochloride form is a photosensitizing product for cutaneous application, marketed under the name of Metvixia ® . Irradiation is performed using a light source with a wavelength between 570 and 670 nm within the absorption spectrum of porphyrins. PDT using Metvixia ® is abbreviated MAL PDT. The light energy absorbed by the photoactive porphyrin is transferred to oxygen, generating ROS. Two MAL PDT sessions 8 days apart are recommended for the treatment of BD.The effectiveness (complete clearance) of PDT for the treatment of BD is approximately 80%, with recurrences in 10-20% of cases (8,11,13). Side-effects are essentially local erythema, oedema, warmth, burning, tingling and painful sensations (13,14).PDT is considered to be a safe treatment, although its carcinogenic risk has never been studied. However, several cases of SCC after PDT have been reported in the literature (15, 16). We studied the occurrence of SCC following PDT treatment in a series of 105 patients with BD. METHODSA monocentric retrospective study of patients with cutaneous BD treated by PDT between 2007 and 2013 was conducted in the Department of Dermatology at Saint Louis Hospital, Paris, France. Data studied were the patients' age, sex, history of SCC, immunosuppression, location of BD treated by PDT, number of treated lesions, number of PDT sessions performed, response to PDT at 3 months, and occurrence of SCC on a PDT field or outside a PDT field. The fields treated with PDT were classified into 4 regions: head and neck, trunk, upper limbs and lower limbs. The efficacy of PDT on BD 3 months after therapy was qualified as complete response (CR) when complete regression of the lesion occurred, partial response (PR) when part of the BD lesi...

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Section: Resultssupporting

confidence: 49%

Squamous Cell Carcinoma Following Photodynamic Therapy for Cutaneous Bowen’s Disease in a Series of 105 Patients

Ratour-Bigot

Chemidling²,

Montlahuc³

et al. 2016

Acta Derm Venerol

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“…83 A comparison of MAL-PDT with topical 5-FU in only five OTRs with SCC in situ is discussed in section 11.2.…”

Section: 78-82mentioning

confidence: 99%

BritishAssociation ofDermatologists' guidelines for the management of squamous cell carcinomain situ(Bowen's disease) 2014

et al. 2014

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“…AK clearance with ALA-PDT appears equally effective in immunosuppressed and immunocompetent people. 100 In one study of OTRs with a prior history of SCCs, ALA-PDT was administered on a cyclic basis with pretreatment curettage of hyperkeratotic AKs. Patients received up to 14 treatments over 2 years.…”

Section: Aks In Organ Transplant Recipientsmentioning

confidence: 99%

Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

et al. 2015

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Background Actinic keratosis (AK) and cheilitis (AC) are lesions that develop on photodamaged skin and may progress to form invasive squamous cell carcinomas (SCCs). Objective To provide guidance to Canadian health care practitioners regarding management of AKs and ACs. Methods Literature searches and development of graded recommendations were carried out as discussed in the accompanying introduction (chapter 1 of the NMSC guidelines). Results Treatment of AKs allows for secondary prevention of skin cancer in sun-damaged skin. Because it is impossible to predict whether a given AK will regress, persist, or progress, AKs should ideally be treated. This chapter discusses options for the management of AKs and ACs. Conclusions Treatment options include surgical removal, topical treatment, and photodynamic therapy. Combined modalities may be used in case of inadequate response. AKs are particularly common following the longterm immunosuppression in organ transplant patients, who should be monitored frequently to identify emerging lesions that require surgery.

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Topical photodynamic therapy in the treatment of actinic keratoses and Bowen’s disease in transplant recipients

Abstract: Topical PDT with 20% 5-ALA is an effective and safe treatment for AK and BD in immunosuppressed TR, with initial response rates comparable with those in immunocompetent patients. It is particularly useful in TR because of the possibility for repeated treatment of large lesional areas.

Cited by 156 publications

References 25 publications

Squamous Cell Carcinoma Following Photodynamic Therapy for Cutaneous Bowen’s Disease in a Series of 105 Patients

Squamous Cell Carcinoma Following Photodynamic Therapy for Cutaneous Bowen’s Disease in a Series of 105 Patients

BritishAssociation ofDermatologists' guidelines for the management of squamous cell carcinomain situ(Bowen's disease) 2014

Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

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