Methyl-aminolevulinate photodynamic therapy for the treatment of actinic keratoses and non-melanoma skin cancers: a retrospective analysis of response in 462 patients.

AIM: Topical photodynamic therapy (PDT) with methyl-aminolevulinate (MAL) is widely used for the management of actinic keratoses (AK) and non-melanoma skin cancers (NMSCs). The authors report the results of a retrospective chart review showing the cumulative four-year experience with MAL-PDT in a hospital outpatient setting.

METHODS: The medical records selected concerned all patients who completed the MAL-PDT regimen (one single session for AK and two sessions one week apart for NMSCs) and who underwent post-treatment assessments over a follow-up period of at least 12 months.

RESULTS: Present case series included a total of 462 patients: 210 patients with AK, 228 subjects with 348 basal cell carcinomas (BCCs), 213 of nodular type (nBCC) and 135 of superficial type (sBCC), 17 patients with Bowen's disease and seven with squamous cell carcinoma. On the whole, following a single session, complete clearance of AK was achieved in 79% of patients at three months and in 68.1% at 12 months. As concerns BCCs, regardless of the clinical type, a complete response was observed in 71% of lesions at three months, with a rate of recurrence at 12 months of 15%. The risk of both initial treatment failure and recurrence was higher for nBCCs than sBCCs. Our results, even if obtained in very few cases, indicate that Bowen's disease is very responsive to MAL-PDT, unlike microinvasive or invasive SCC. Treatment was generally well tolerated.

CONCLUSIONS: Our experience confirms that MAL-PDT is a valid approach to patients with AK, BCC and Bowen's disease, with an acceptable tolerability profile and a very low risk of complications.