Treatment of Gorlin syndrome (nevoid basal cell carcinoma syndrome) with methylaminolevulinate photodynamic therapy in seven patients, including two children: interest of tumescent anesthesia for pain control in children.

OBJECTIVE: To report our experience of methylaminolevulinate photodynamic therapy (MAL-PDT) in the treatment of multiple basal cell carcinoma (BCC) in adults and children with Gorlin syndrome (GS). DESIGN: Report of cases. SETTING: University of Montpellier, Department of Dermatology. PATIENTS: Seven Gorlin patients (41 superficial or nodular carcinomas), including two children. INTERVENTIONS: Prior superficial curettage for superficial BBCs or debulking for nodular BCCs was systematically performed. Methylaminolevulinic acid was applied topically to lesions 3 h before illumination with 635 nm red light for 10 min (37 J/cm(2)). To prevent treatment discomfort, analgesics and/or cooling by sprayed water were most often provided, and occasionally 1% lidocaine local anesthesia. A ropivacaine-lidocaine tumescent anesthesia was performed on the youngest patient. MAIN OUTCOME MEASURES: The initial response rate; tolerance, particularly in children; cosmetic outcome. RESULTS: Overall clearance in patients was 60% after one session of MAL-PDT and 78% after three sessions. Resolution of the lesions was accompanied by an excellent cosmetic outcome in all patients. Treatments were well tolerated in adults with moderate pain sensation during illumination. In a child, tumescent anesthesia assured excellent tolerance in all treatment stages. CONCLUSION: We add our experience to previous articles that consider PDT as an interesting option in the treatment of GS. To our knowledge, this study is the first report of MAL-PDT in GS children using tumescent anesthesia. Specific guidelines for adult and pediatric patients remain to be established.