PDT for Basal Cell Carcinoma: A Long-Term Follow-Up

This was in journal watch. Does anyone use DMSO?



Long-term results show 5-aminolevulinic acid photodynamic therapy to be beneficial for basal cell carcinomas when surgery is not a good option.

Although surgical removal is the mainstay of basal cell carcinoma (BCC) therapy, additional options are desirable in some situations. One alternative is 5-aminolevulinic acid photodynamic therapy (ALA-PDT), but data are scarce concerning which BCC types are amenable to this treatment and long-term outcomes. In this study, investigators treated 60 BCCs in 44 patients with one or two sessions of ALA-PDT and followed them for 10 years. Morpheaform and pigmented BCCs were excluded from treatment, but recurrent lesions were included. The protocol involved debulking of the tumor, treatment with the drug penetration enhancer dimethylsulfoxide (DMSO) for 5 minutes, followed by ALA-PDT. ALA was activated by a broadband light unit with an emission spectrum in the 550–700 nm range.

The 10-year complete response rates were 87% with two treatment sessions and 60% with one session. All recurrences developed within 3 years of treatment. At 10 years, 90% of the primary tumors were recurrence free, but ALA-PDT was effective for only two of the five recurrent tumors. Recurrences were more likely in men. Physician evaluators considered the cosmetic outcome to be excellent or good in 90% of treated sites at 1 year and in 100% at 10 years.

Comment: Long-term results with 5-aminolevulinic acid photodynamic therapy for basal cell carcinomas are very positive — comparable to other nonsurgical interventions. Longer-wavelength light sources in the 625-nm range (as used in this study) are probably the best choice for BCC treatment, because they penetrate more deeply into the skin than shorter-wavelength blue lights. The authors speculate that DMSO may have contributed to efficacy by augmenting conversion of ALA to its active metabolite. Dermatologists may wish to consider ALA-PDT for primary BCCs when surgical procedures should be avoided.

 Craig A. Elmets, MD

Published in Journal Watch Dermatology June 15, 2012


Christensen E et al. High and sustained efficacy after two sessions of topical 5-aminolaevulinic acid photodynamic therapy for basal cell carcinoma: A prospective, clinical and histological 10-year follow-up study. Br J Dermatol 2012 Jun; 166:1342.

  1. #1 by Alan Cameron on June 16, 2012 - 2:50 am

    Hey Ian I know I don’t comment very often, but I certainly do have a look at most of your posts, and generally find them very useful.

    So consider this a vote of thanks for the time and effort you put into this blog, I greatly appreciate it!

  2. #2 by Dr Ian Katz on June 17, 2012 - 12:42 am

    Thanks Alan

  3. #3 by paulob68 on June 18, 2012 - 3:43 am

    Ditto Alan’s comments.
    Interesting the inclusion of DMSO in the PDT protocol in the study. Unfortunately that makes the results difficult to interpret in most settings where DMSO not used.
    60 % after 10 years with one PDT treatment indicates this should never be appropriate treatment.

  4. #4 by Graeme Siggs on June 19, 2012 - 1:40 am

    ALA-PDT is not approved for the treatment of BCC in Australia.
    Only MAL-PDT (Metvix) is approved for this use in Australia.
    And interestingly DMSO is one of the ingredients in Cansema (Black Salve)!

  5. #5 by John Ku on June 19, 2012 - 1:49 pm

    Hi Ian, Very interesting, definitely has a role in clinical practice, especially when surgery is not an option and compliance with imiquimoid is poor. I will look out for DMSO and keep you posted.

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