Topical photodynamic therapy (PDT) is used to treat nonmelanoma skin cancers, such as actinic keratoses, Bowen's disease, and basal cell carcinoma (superficial and nodular). This article presents ...up-to-date, practical, evidence-based recommendations on the use of topical PDT using 5-aminolevulinic acid or methyl aminolevulinate for the treatment (and prevention) of nonmelanoma skin cancers. A systematic literature review was conducted (using MEDLINE), and recommendations were made on the basis of the quality of evidence for efficacy, safety/tolerability, cosmetic outcome, and patient satisfaction/preference. Topical PDT is highly effective in the treatment of actinic keratoses, Bowen's disease, superficial and thin nodular basal cell carcinomas, with cosmesis typically superior to that achieved with existing standard therapies. PDT may also be a means of preventing certain nonmelanoma skin cancers in immunosuppressed patients.
Topical photodynamic therapy (PDT) using the methyl ester of 5-aminolaevulinic acid (MAL) is an effective therapy for actinic keratoses and Bowen's disease. Thin and moderate thickness facial actinic ...keratoses respond best, with clearance rates equivalent or superior (depending on protocol) to current therapy, and with notably superior cosmetic outcome. Patients with areas of field cancerization and organ transplant recipients may particularly benefit from topical MA-PDT. The response rate of Bowen's disease to MAL-PDT is also at least equivalent to cryotherapy and 5-fluorouracil, again with superior cosmesis. Patients with large or multiple lesions of Bowen's disease or those in whom standard therapy, including surgery, is relatively contraindicated may particularly benefit from PDT.
