The authors decided to evaluate the possible use of methyl-aminolevulinate photodynamic therapy
(MAL-PDT) as adjunctive therapy for morpheaform basal cell carcinoma prior to standard surgical
excision in order to reduce tumor size and volume and to facilitate surgical treatment. It was observed
that MAL-PDT may be an option as an adjunctive therapy prior to standard surgical excision of
morpheaform basal cell carcinoma, leading to less invasive surger

Costa, V:

Fernandes, I.

Selores, M.

Torres, T.

Acta Dermatovenerologica Alpina Pannonica et Adriatica

Repositório Científico da Unidade Local de Saúde de Santo António

23Photodynamic therapy as adjunctive therapy for morpheaform basal cell carcinomaActa Dermatoven APA Vol 20, 2011, No 1C a s e  r e p o r tK E YW O R D Sphotodynamic therapy, morpheaform basal cell carcinoma, adjunctive therapyPhotodynamic therapy as adjunctive therapy for morpheaform basal cell carcinoma77RUUHV,)HUQDQGHV9&RVWD06HORUHVThe authors decided to evaluate the possible use of methyl-aminolevulinate photodynamic therapy (MAL-PDT) as adjunctive therapy for morpheaform basal cell carcinoma prior to standard surgical excision in order to reduce tumor size and volume and to facilitate surgical treatment. It was obser-ved that MAL-PDT may be an option as an adjunctive therapy prior to standard surgical excision of morpheaform basal cell carcinoma, leading to less invasive surgery.S U M M A R YTopical photodynamic therapy has demonstrated KLJKHIÀFDF\ LQ WKH WUHDWPHQWRIQRQPHODQRPDVNLQcancers such as actinic keratoses, Bowen’s disease, DQGEDVDOFHOOFDUFLQRPDVXSHUÀFLDODQGQRGXODU%H-cause of its excellent cosmetic results it has also been XVHGZLWKJRRGUHVXOWVLQ´GLIÀFXOWWRWUHDWµEDVDOFHOOcarcinomas (large lesions, multifocal, or mid-facially ORFDOL]HGOHVLRQVWKDWZRXOGRWKHUZLVHUHTXLUHH[WHQ-sive surgical procedures (1). Morpheaform basal cell carcinoma is a rare variant in which tumor cells induce DSUROLIHUDWLRQRIÀEUREODVWVZLWKLQWKHGHUPLVDQGDQincreased collagen deposition that clinically resembles D VFDU%HFDXVH WKH WXPRU LQÀOWUDWHV LQ WKLQ VWUDQGVEHWZHHQFROODJHQÀEHUVWUHDWPHQWLVGLIÀFXOWDQGWKHFOLQLFDOPDUJLQV DUHGLIÀFXOW WRGLVWLQJXLVK6XUJHU\particularly Mohs surgery, is the treatment of choice for this type of basal cell carcinoma.The authors decided to evaluate the possible use of methyl-aminolevulinate photodynamic therapy (MAL-PDT) as an adjunctive therapy for morphea-form basal cell carcinoma prior to standard surgical excision (Mohs surgery is not available at our center) LQRUGHUWRUHGXFHWXPRUVL]HDQGYROXPHDQGIDFLOL-tate surgical treatment. Therefore, the aim was to as-sess if this approach could lead to less invasive sur-gery, which can be particularly relevant in the excision of basal cell carcinomas on the face.6L[ KLVWRORJLFDOO\ FRQÀUPHG PRUSKHDIRUP EDVDOcell carcinomas were carefully selected (Fig. 1). Three tumors were located on the face and three on the back. The lesion dimensions (clinical dimensions) and location are shown in Table 1. Two treatments with 0$/3'7ZHHNDSDUWZHUHSHUIRUPHGDQDSSOLFD-tion of approximately 1 mm thick of 160 mg/g MAL cream (Metvix®, Galderma, France) was applied on the lesion and 5 to 10 mm of surrounding skin. The lesion was then covered by an adhesive, occlu-sive dressing for 3 hours, after which time the cream was removed by rinsing with saline solution. The le-sion was immediately illuminated with an LED light 24Photodynamic therapy as adjunctive therapy for morpheaform basal cell carcinoma Acta Dermatoven APA Vol 20, 2011, No 1C a s e  r e p o r tsource (Aktilite® CL16 & CL128 lamps, PhotoCure ASA, Norway) which emits red light at an average wavelength of approximately 630 nm at a dosage of 37 J/cm². The patients were examined to assess the clini-cal response 3 weeks after the two treatments with 0$/3'7DQGWKHFOLQLFDOVL]HRIDOOWKHWXPRUVZDVVLJQLÀFDQWO\UHGXFHG²7KHVXUJLFDOH[FLVLRQVperformed (traditional surgery, because Mohs surgery is not available at our center) with 5 mm margins were less extensive that those that would have been neces-VDU\ LQLWLDOO\ EHFDXVH WKH FOLQLFDO VL]HV RI DOO WXPRUVZHUHVLJQLÀFDQWO\UHGXFHG+LVWRSDWKRORJLFDOO\DOOWKHexcision margins were tumor-free. After 2½ years, all the patients remained without any evidence of recur-rence and the cosmetic outcome was considered very good (Fig. 2).Combining more than one therapeutic modality has the potential advantage of enhancing the cure UDWHZKLOHPLQLPL]LQJDGYHUVHHIIHFWV DQGPD[LPL]-ing cosmetic results. The use of an adjunctive therapy prior to surgical treatment may allow a reduction in tumor volume along with the possible induction of an immune response to the tumor, facilitating excision RIWKHFDQFHU7RSLFDOÁXRURXUDFLOFUHDPRUimiquimod cream has been used to pretreat basal cell carcinoma prior to surgery, leading to a decrease in WKHHYHQWXDOZRXQGVL]H&RPELQDWLRQWKHUDS\with methyl-aminolevulinate photodynamic therapy (MAL-PDT) and imiquimod cream has also been reported in the treatment of nodular basal cell carci-noma (5).Important limitations of this study obviously in-clude the small number of patients and the fact that ÁXRUHVFHQFHVWXGLHVZHUHQRWSHUIRUPHGIROORZLQJWKHMAL application, which could have offered additional SURRIRIWKHEHQHÀFLDOHIIHFWRIWKH0$/3'7Although no reports can be found in the literature concerning the use of topical photodynamic therapy in the treatment of morpheaform basal cell carcinoma, and despite the small number of patients taken into consideration, this preliminary study has found that MAL-PDT may be an option as an adjunctive therapy prior to standard surgical excision of morpheaform basal cell carcinoma, especially when Mohs surgery is not available. Further studies and longer clinical fol-ORZXSVDUHQHFHVVDU\WRFRQÀUPRXUÀQGLQJVFigure 1. Histopathological examination  (H&E, 4×).Figure 2. Clinical features of the lesion before treatment (a); 3 weeks after two treatments with MAL-PDT 1 week apart (b); 18-month follow-up after PDT and surgical excision (c and d).Table 1. Lesion location and clinical dimensions.Case Location Clinical size 1 Face (malar) 2.7 cm × 1.6 cm2 Face (mandibular) 2.5 cm × 1.3 cm3 Face (cheek) 2.0 cm × 0.9 cm4 Dorsum 3.7 cm × 2.3 cm5 Dorsum 2.9 cm × 1.9 cm6 Presternal 3.5 cm × 1.7 cm25Photodynamic therapy as adjunctive therapy for morpheaform basal cell carcinomaActa Dermatoven APA Vol 20, 2011, No 1C a s e  r e p o r t1. 9LQFLXOOR&(OOLRWW7)UDQFLV'*HEDXHU.6SHOPDQ/1JX\HQ5HWDO3KRWRG\QDPLF WKHUDS\ZLWKWRSLFDOPHWK\ODPLQRODHYXOLQDWHIRU³GLI¿FXOWWRWUHDW´EDVDOFHOOFDUFLQRPD%U-'HUPDWRO± &HLOOH\5,'HO5RVVR-4&XUUHQWPRGDOLWLHVDQGQHZDGYDQFHVLQWKHWUHDWPHQWRIEDVDOFHOOFDUFLQRPD,QW-'HUPDWRO±3. %XWOHU')3DUHNK3./HQLV$,PLTXLPRGFUHDPDVDGMXQFWLYHWKHUDS\IRUSULPDU\VROLWDU\QRGXODUQDVDO EDVDO FHOO FDUFLQRPDV EHIRUH 0RKV PLFURJUDSKLF VXUJHU\ D UDQGRPL]HG GRXEOH EOLQG YHKLFOHFRQWUROOHGVWXG\'HUPDWRO6XUJ±4. 7XUDQ$6DULFDRJOX+%DVNDQ(%7RNHU6&7XQDOL67UHDWPHQWRI LQ¿OWUDWLQJEDVDO FHOO FDUFLQRPDZLWK WKH FRPELQDWLRQ RI LQWUDOHVLRQDO ,)1DOSKDE DQG WRSLFDO LPLTXLPRG  FUHDP ,QW - 'HUPDWRO±5. 'HYLUJLOLLV93DQDVLWL9&XU]LR0*REEL65RVVL05REHUWL9HWDO&RPSOHWHUHPLVVLRQRIQRGXODUEDVDO FHOO FDUFLQRPD DIWHU FRPELQHG WUHDWPHQWZLWK SKRWRG\QDPLF WKHUDS\ DQG LPLTXLPRG  FUHDP'HUPDWRO2QOLQH-Tiago Torres, MD, Department of Dermatology, Centro Hospitalar do Porto – Hospital de Santo António, Edifício das Consultas Externas do Hospital Geral Santo António, Ex. CICAP, Rua D. Manuel II, s/n, 4100 Porto, Portugal, E-mail: tiagotorres2002@hotmail.comIolanda Fernandes, MD, same address, E-mail: iolandacfernandes@iol.ptVirgílio Costa, MD, same address, E-mail: madalenavsanches@gmail.comManuela Selores, MD, same address, E-mail: dermat@sapo.ptR EFER ENCESA U T H O R S ’A D D R E S S E S

Photodynamic therapy as adjunctive therapy for morpheaform basal cell carcinoma

http://repositorio.chporto.pt/bitstream/10400.16/868/1/Photodynamic%20therapy%20as%20adjunctive%20therapy%20for%20morpheaform%20basal%20cell%20carcinoma.pdf

Photodynamic therapy as adjunctive therapy for morpheaform basal cell carcinoma

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