Photodynamic therapy combined with cryotherapy for the treatment of nodular basal cell carcinoma

Abstract

Carbon dioxide (CO₂) laser ablation in combination with photodynamic therapy (PDT) has previously been successfully used to treat superficial basal cell carcinoma (BCC). However, the efficacy of this treatment modality is limited in the treatment of deeper lesions and the more aggressive subtypes of BCC. In order to improve the outcome of PDT, 8 BCC lesions of variable depths (4 lesions ≤2 mm and 4 lesions >2 mm) and subtypes (1 superficial, 6 nodular and 1 infiltrative) were treated with CO₂ laser ablation in combination with PDT, followed by modified cryotherapy. The mean number of treatment sessions was 1.5 and the follow-up period was 22 months. All of the patients demonstrated a complete response and no recurrence of disease, while the majority of patients were satisfied with the cosmetic results upon follow-up examination. The combination therapy of CO₂ laser ablation with PDT followed by modified cryotherapy demonstrated a good efficacy and satisfactory cosmetic outcomes in the treatment of nodular BCC.

Keywords: basal cell carcinoma; carbon dioxide laser; cryotherapy; photodynamic therapy.

Figure 1

(A) Schematic figure depicting CO₂ laser ablation along the tumor border and MAL application within a 2-mm tumor margin. (B) A cryostick constructed from solid carbon dioxide was applied to the lesion twice for 5 sec each time. MAL, methyl aminolevulinate; CO₂, carbon dioxide.

Figure 2

Nodular BCC lesion on the left temple of patient 5. Clinical images (A) prior to and (B) following combined PDT treatment. Histological images (C) prior to and (D) following treatment. BCC, basal cell carcinoma; PDT, photodynamic therapy.

Figure 3

Nodular BCC lesion on the nose of patient 3. Clinical images (A) prior to and (B) following combined PDT treatment. Histological images (C) prior to and (D) following treatment. BCC, basal cell carcinoma; PDT, photodynamic therapy.

Figure 4

Superficial BCC lesion on the right thigh of patient 1. Clinical images (A) prior to and (B) following combined PDT treatment. Histological images (C) prior to and (D) following treatment. BCC, basal cell carcinoma; PDT, photodynamic therapy.