Tumor depth is the limiting factor for topical photodynamic therapy (PDT) treating cutaneous invasive squamous cell carcinoma (SCC). The thickness of < 2–3 mm below the epidermis is the currently recommended effective response depth in nonmelanoma skin cancers. We report an unusual outgrowing SCC with a tumor depth of 5.5 mm, which was successfully treated with PDT.
Methods:
Topical 20% (wt/wt) 5-aminolaevulinic acid emulsion was applied for 6 h before irradiation with 633-nm red light. The lesion was irradiated 7 times, 1 week apart, at a total dose of 791 J/cm2.
Results:
Twelve months later, histologic and clinical examination showed a complete remission and no local or systemic metastases. No serious side effects occurred, and the cosmetic outcome was excellent.
Conclusion:
PDT may offer a noninvasive, well-tolerated, and effective therapy for inoperable low-risk SCC with an outgrowing pattern. It suggests that tumor depth is not an absolute predictor, but only a suggested reference.
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References
1.
RhodesLE., De-RieM., EnstromY.et al.2004. Photodynamic therapy using topical methyl aminolevulinate vs surgery for nodular basal cell carcinoma: results of a multicenter randomized prospective trial. Arch. Dermatol., 140:17–23.
2.
XuS., WangX., XuW., XiaY., ZhangC.2002. Evaluation of photodynamic therapy of skin cancers with partial differential alpha-aminolevulinic acid. Chin. Med. J. (Engl.), 115:1141–1145.
3.
SzeimiesR.M., KarrerS., Radakovic-FijanS.et al.2002. Photodynamic therapy using topical methyl 5-aminolevulinate compared with cryotherapy for actinic keratosis: a prospective, randomized study. J. Am. Acad. Dermatol., 47:258–262.
4.
Calzavara-PintonP.G., VenturiniM., SalaR.et al.2008. Methylaminolaevulinate-based photodynamic therapy of Bowen's disease and squamous cell carcinoma. Br. J. Dermatol., 159:137–144.
5.
KesslerG.M., AckermanA.B.2006. Nomenclature for very superficial squamous cell carcinoma of the skin and of the cervix: a critique in historical perspective. Am. J. Dermatopathol., 28:537–545.
6.
MortonC.A., BrownS.B., CollinsS.et al.2002. Guidelines for topical photodynamic therapy: report of a workshop of the British Photodermatology Group. Br. J. Dermatol., 146:552–567.
7.
MortonC.A., McKennaK.E., RhodesL.E.2008. Guidelines for topical photodynamic therapy: update. Br. J. Dermatol., 159:1245–1266.
8.
WolfP., RiegerE., KerlH.1993. Topical photodynamic therapy with endogenous porphyrins after application of 5-aminolevulinic acid: an alternative treatment modality for solar keratoses, superficial squamous cell carcinomas, and basal cell carcinomas?J. Am. Acad. Dermatol., 28:17–21.
9.
Fink-PuchesR., SoyerH.P., HoferA., KerlH., WolfP.1998. Long-term follow-up and histological changes of superficial nonmelanoma skin cancers treated with topical delta-aminolevulinic acid photodynamic therapy. Arch. Dermatol., 134:821–826.
AhmadiS., McCarronP.A., DonnellyR.F., WoolfsonA.D., McKennaK.2004. Evaluation of the penetration of 5-aminolevulinic acid through basal cell carcinoma: a pilot study. Exp. Dermatol., 13:445–451.
12.
BirdS.B., DicksonE.W.2001. Clinically significant changes in pain along the visual analog scale. Ann. Emerg. Med., 38:639–643.
13.
LeibovitchI., HuilgolS.C., SelvaD., HillD., RichardsS., PaverR.2005. Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia, I: experience over 10 years. J. Am. Acad. Dermatol., 53:253–260.
14.
HumphreysT.R., MalhotraR., ScharfM.J., MarcusS.M., StarkusL., CalegariK.1998. Treatment of superficial basal cell carcinoma and squamous cell carcinoma in situ with a high-energy pulsed carbon dioxide laser. Arch. Dermatol., 134:1247–1252.
15.
RyanR.F., LitwinM.S., ReedR.J.1971. Topical use of 5-fluorouracil cream for skin cancer. Mod. Trends Surg., 3:284–296.
16.
KuflikE.G., GageA.A.1991. The five-year cure rate achieved by cryosurgery for skin cancer. J. Am. Acad. Dermatol., 1,24:1002–1004.
17.
IkicD., PadovanI., PipicN.et al.1995. Interferon reduces recurrences of basal cell and squamous cell cancers. Int. J. Dermatol., 34:58–60.
18.
CopperM.P., TriesscheijnM., TanI.B., RuevekampM.C., StewartF.A.2007. Photodynamic therapy in the treatment of multiple primary tumours in the head and neck, located to the oral cavity and oropharynx. Clin. Otolaryngol. 1, 32:185–189.
19.
MortonC.A., MacKieR.M., WhitehurstC., MooreJ.V., McCollJ.H.1998. Photodynamic therapy for basal cell carcinoma: effect of tumor thickness and duration of photosensitizer application on response. Arch. Dermatol., 134:248–249.
20.
JuzenieneA., JuzenasP., MaL.W., IaniV., MoanJ.2004. Effectiveness of different light sources for 5-aminolevulinic acid photodynamic therapy. Lasers Med. Sci., 19:139–149.
21.
KyriaziM., AlexandratouE., YovaD., RallisM., TrebstT.2008. Topical photodynamic therapy of murine non-melanoma skin carcinomas with aluminum phthalocyanine chloride and a diode laser: pharmacokinetics, tumor response and cosmetic outcomes. Photodermatol. Photoimmunol. Photomed., 24:87–94.
22.
HentaT., ItohY., KobayashiM., NinomiyaY., IshibashiA.1999. Photodynamic therapy for inoperable vulval Paget's disease using delta-aminolaevulinic acid: successful management of a large skin lesion. Br. J. Dermatol., 141:347–349.
23.
CassarinoD.S., DerienzoD.P., BarrR.J.2006. Cutaneous squamous cell carcinoma: a comprehensive clinicopathologic classification. Part one. J. Cutan. Pathol., 33:191–206.
24.
AckroydR., BrownN.J., DavisM.F.et al.2000. Photodynamic therapy for dysplastic Barrett's oesophagus: a prospective, double blind, randomised, placebo controlled trial. Gut, 47:612–617.
25.
BodnerK., Bodner-AdlerB., WierraniF.et al.2003. Cold-knife conization versus photodynamic therapy with topical 5-aminolevulinic acid (5-ALA) in cervical intraepithelial neoplasia (CIN) II with associated human papillomavirus infection: a comparison of preliminary results. Anticancer Res., 23:1785–1788.
26.
Gronlund-PakkanenS., PakkanenT.M., KoskiE., TaljaM., Ala-OpasM., AlhavaE.2001. Effect of photodynamic therapy on urinary bladder function: an experimental study with rats. Urol. Res., 29:205–209.
27.
GoldM.H., GoldmanM.P.2004. 5-Aminolevulinic acid photodynamic therapy: where we have been and where we are going?Dermatol. Surg., 30:1077–1083discussion 1083–1074.
28.
FukuiT., WatanabeD., TamadaY., MatsumotoY.2009. Photodynamic therapy following carbon dioxide laser enhances efficacy in the treatment of extramammary Paget's disease. Acta Derm. Venereol., 89:150–154.
29.
PagliaroJ., ElliottT., BulsaraM., KingC., VinciulloC.2004. Cold air analgesia in photodynamic therapy of basal cell carcinomas and Bowen's disease: an effective addition to treatment: a pilot study. Dermatol. Surg., 30:63–66.
30.
BabilasP., KnoblerR., HummelS.et al.2007. Variable pulsed light is less painful than light-emitting diodes for topical photodynamic therapy of actinic keratosis: a prospective randomized controlled trial. Br. J. Dermatol., 157:111–117.
