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Who’s the Winner: Topical Photodynamic Therapy vs. Surgical Excision for Nodular BCC Treatment

Topical photodynamic therapy (PDT) has advantages over the previous first-line treatment for basal cell carcinoma (BCC). Surgical excision (SE) clears the tumor, but the resulting scars may be unacceptable and there are risks of bleeding and infections.

PDT has been attracting interest to treat skin cancers because it is effective with few adverse effects, its non-invasive, and it minimally damages the surrounding tissue. Thus, using PDT over SE in cosmetically sensitive areas, such as the neck and face, may be advantageous because it reduces risk of scars.

The 2013 European guidelines for PDT reflected its use as treatment for nodular basal cell carcinoma (nBCC).  Supporting evidence includes several small randomized controlled trials (RCTs) that have compared PDT to SE to treat nBCC. A recent study reviewed the literature of PDT treatment for nBCC to evaluate evidence for its use.

The authors identified 261 studies based on the search criteria. After accounting for inclusion and exclusion criteria, five studies were chosen where PDT and SE were directly compared. The studies included a total of 596 pathological-verified nodular BCC patients; 295 were given PDT treatment. The results show that in agreement with the conclusion reached by the European guidelines, PDT is suitable treatment compared to SE. Differences in complete response rates at all follow-ups were comparable between PDT and SE. For cosmetic outcomes for both treatments, PDT was better than SE. However, when PDT was used, there was an increased cumulative probability of recurrence. Modifying PDT methods can increase its effectiveness and reduce recurrences. The authors caution that there are few articles that compare PDT and SE and samples are small. Larger RCTs are needed to draw conclusions.


Byline: Martha L. Sikes, MS, RPh, PA-C

Posted: February 27, 2017

Source: Journal of Cosmetic Dermatology
Adapted from the original article.

[Image: Martha L. Sikes]

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