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Allan R. Oseroff, MD, PhD; Sherry Shieh, MD; Noreen P. Frawley, RN; Richard Cheney, MD; Leslie E. Blumenson, PhD; Eniko K. Pivnick, MD; David A. Bellnier, PhD

Arch Dermatol. 2005;141:60-67.

Objective  To report the use of wide-area 5-aminolevulinic acid photodynamic therapy to treat numerous basal cell carcinomas (BCCs) and basaloid follicular hamartomas (BFHs).

Design  Report of cases.

Setting  Roswell Park Cancer Institute.

Patients  Three children with BCCs and BFHs involving 12% to 25% of their body surface areas.

Interventions  Twenty percent 5-aminolevulinic acid was applied to up to 22% of the body surface for 24 hours under occlusion. A dye laser and a lamp illuminated fields up to 7 cm and 16 cm in diameter, respectively; up to 36 fields were treated per session.

Main Outcome Measures  Morbidity, patient response, and light dose–photodynamic therapy response relationship and durability.

Results  Morbidity was minimal, with selective phototoxicity and rapid healing. After 4 to 7 sessions, with individual areas receiving 1 to 3 treatments, the patients had 85% to 98% overall clearance and excellent cosmetic outcomes without scarring. For laser treatments, a sigmoidal light dose–response relationship predicted more than 85% initial response rates for light doses 150 J/cm² or more. Responses were durable up to 6 years.

Conclusion  5-Aminolevulinic acid photodynamic therapy is safe, well tolerated, and effective for extensive areas of diffuse BCCs and BFHs and appears to be the treatment of choice in children.

Author Affiliations: Departments of Dermatology (Drs Oseroff and Shieh and Ms Frawley) and Pathology (Dr Cheney) and Photodynamic Therapy Center (Dr Bellnier), Roswell Park Cancer Institute, Department of Dermatology, State University of New York at Buffalo (Drs Oseroff and Shieh and Ms Frawley), and Biostatistical Consulting Services (Dr Blumenson), Buffalo; and Departments of Pediatrics and Ophthalmology, University of Tennessee, Memphis (Dr Pivnick).

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