Long-term recurrence of nonmelanoma skin cancer after topical methylaminolevulinate photodynamic therapy in a dermato-oncology department

Abstract: BACKGROUND: Most available studies on the efficacy of topical photodynamic therapy focus on short-to medium-term results. Long-term data are scarce. OBJECTIVE: To evaluate the long-term efficacy of photodynamic therapy with topical methylaminolevulinate to treat Bowen's disease and basal cell carcinoma in the clinical practice setting of a dermato-oncology department. METHODS: The study included patients diagnosed with Bowen's disease or basal cell carcinoma, and who received photodynamic therapy from 2004 to 2008. Treatment protocol and clinical follow-up were standardized. The primary endpoint was clinically observed recurrence in a previous photodynamic therapy-treated area. Descriptive and survival analyses were performed. RESULTS: A total of 31 Bowen's disease lesions and 44 superficial basal cell carcinoma were treated, with a median follow-up of 43.5 months. Recurrence was observed in 14 Bowen's disease lesions (53.8%) and in 11 superficial basal cell carcinoma (33.3%). Significantly higher estimates for recurrence rates were found in patients with Bowen's disease (p=0.0036) or those aged under 58 years (p=0.039). The risk of recurrence was higher in patients with Bowen's disease than in those with superficial basal cell carcinoma and younger patients. CONCLUSIONS: Recurrence should be considered when choosing to treat non-melanoma skin cancer with photodynamic therapy. Younger age and Bowen's disease were independent predictors for long-term recurrence, suggesting the need to establish an extended period of follow-up for this subset of patients.

Photodynamic therapy in actinic cheilitis: clinical and anatomopathological evaluation of 19 patients / Tratamento de queilite actínica com terapia fotodinâmica: avaliação clínica e anatomopatológica de 19 pacientes

BACKGROUND: Actinic cheilitis, a common disease caused by chronic solar exposure and tobacco use, is considered a premalignant lesion with potential to develop into squamous cell carcinoma. Some of the available treatments are invasive, have unaesthetic results and require multiple sessions. OBJECTIVE: To assess the efficacy of a therapy and its cosmetic results. METHODS: In this uncontrolled clinical trial a single photodynamic therapy (PDT) session using 16% methyl-aminolevulinate was performed on actinic cheilitis of the lower lip. A standardized questionnaire was applied in order to assess the clinical improvement from the patients' point of view and the satisfaction with the treatment. Anatomopathological evaluation was performed before the treatment and two months afterwards. RESULTS: The sample was composed of 19 patients (10 males and 9 females), phototypes I to III, with average age of 62 years. Main adverse effects were: sudden pain, scabs, herpes flare-up, and edema. The average score of pain during the procedure was 5,8+2,9. At the final assessment the patients reported improvement of 80% and satisfaction of 85% (p<0.01). Anatomopathological analysis showed a significant decrease of dysplasia (p=0.03) in spite of its presence in 84% of cases. There was no significant correlation between the level of dysplasia with either the subjective impression of clinical improvement (p=0.82) or with the patients' final satisfaction (p=0.96). CONCLUSION: PDT is effective in the treatment of actinic cheilitis, but it is associated with a significant level of pain. Due to the persistence of dysplasia, more research needs to be done in order to define the ideal number of sessions for the effective treatment of these lesions.

FUNDAMENTOS: Queilite actínica, afecção causada por exposição solar crônica e tabagismo, é considerada lesão pré-maligna com possibilidade de transformação para carcinoma espinocelular. Alguns tratamentos descritos são invasivos, têm resultados inestéticos e requerem múltiplas aplicações. OBJETIVO: Verificar o uso de tratamento efetivo com resultado esteticamente aceitável. MÉTODOS: Ensaio clínico não controlado, utilizando terapia fotodinâmica com cloridrato de aminolevulinato de metila creme 16%, única aplicação, na queilite actínica de lábio inferior. Aplicação de questionário padronizado para avaliar melhora clínica da lesão subjetiva do paciente e satisfação com tratamento. Avaliação anatomopatológica antes da aplicação e dois meses após. RESULTADOS: Amostra compreendeu 19 pacientes (10 homens e 9 mulheres), fototipos I a IH, idade média 62 anos. Principais efeitos adversos: dor imediata, crostas, herpes labial e edema. Escore médio de dor referida durante o procedimento foi 5,8±2,9. Na avaliação final, os pacientes referiram melhora de 80% das lesões e apresentaram mediana de 85% de satisfação (p<0,01). Análise anatomopatológica mostrou diminuição significativa de displasia (p=0,03), apesar da persistência em 84% dos casos. Não houve correlação significativa da redução no grau de displasia com impressão subjetiva de melhora clínica (p=0,82) ou com satisfação final do paciente (p=0,96). CONCLUSÃO: TFD é efetiva no tratamento da queilite actínica, porém associada a grau significativo de dor. Devido à persistência de displasia, mais estudos são necessários para definir o número ideal de aplicações para tratamento efetivo destas lesões.