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Colin A. Morton, MBChB, MD, MRCP; Colin Whitehurst, PhD; John H. McColl, MA, MSc, CStat; James V. Moore, FRCPath; Rona M. MacKie, DSc, FRCP, FRCPath, FRSE, CBE

Arch Dermatol. 2001;137:319-324.

Background  Photodynamic therapy (PDT) using topical -aminolevulinic acid (-ALA) is an effective treatment for Bowen disease and certain basal cell carcinomas (BCCs), but its place in clinical practice remains to be established. Patients with large and/or multiple lesions of Bowen disease or BCC can represent a considerable therapeutic challenge. We suggest that -ALA PDT may be of particular benefit in such patients.

Observation  In an open study, 35 (88%) of 40 large patches of Bowen disease, all with a maximum diameter greater than 20 mm, cleared following 1 to 3 treatments of -ALA PDT, although 4 patches recurred within 12 months. -Aminolevulinic acid PDT was also used to treat 40 large BCCs, with an identical 88% initial clearance (after 1-3 treatments), with 4 recurrences within 34 months (range, 12-60 months). In 10 further patients with multiple (3) patches of Bowen disease, 44 (98%) of 45 patches cleared following -ALA PDT, although 4 lesions recurred over 12 months. In 3 patients with multiple BCCs, PDT cleared 52 (90%) of 58 lesions, with 2 recurrences during 41 months (range, 12-52 months). Treatments were well tolerated, with only 5 patients with solitary large lesions requiring local anesthesia.

Conclusions  -Aminolevulinic acid PDT is an effective tissue-sparing modality achieving good cosmesis. We propose that -ALA PDT be considered as a first-line therapy for large and/or multiple areas of Bowen disease and superficial BCCs.

From the University Department of Dermatology, Western Infirmary (Drs Morton and MacKie) and the Department of Statistics, University of Glasgow (Mr McColl), Glasgow, Scotland; the Department of Dermatology, Falkirk Royal Infirmary, Falkirk, Scotland (Dr Morton); and the Laser Oncology Programme, Cancer Research Campaign Department of Experimental Radiation Oncology, Paterson Institute for Cancer Research, Christie Hospital, Manchester, England (Drs Whitehurst and Moore).

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