MAL-PDT Reveals Cosmetic Edge Over Excision in BCC

VIENNA — Treatment with methyl aminolevulinate-photodynamic therapy was as effective as surgery for superficial basal cell carcinoma, Dr. Rolf-Markus Szeimies reported in a poster session at the 16th Congress of the European Academy of Dermatology and Venereology.

Among the methods for removal of basal cell carcinomas are simple excision, Mohs surgery, radiotherapy, curettage/electrodessication, and cryosurgery, with the choice of treatment depending on type, size, depth, and location of the lesion.

Methyl aminolevulinate-photodynamic therapy (MAL-PDT) has previously been shown to be as effective as cryotherapy for removal of these lesions and to have superior cosmetic results. Now, in the first multicenter randomized trial comparing MAL-PDT with simple excision, similar findings have been found, according to Dr. Szeimies of the department of dermatology, Regensburg (Germany) University Hospital.

A total of 196 patients whose mean age was 63.8 years were included in the study. The mean number of lesions per patient was 1.4, and the mean diameter of the lesions was 12.4 mm.

Patients randomized to MAL-PDT underwent two treatment sessions 7 days apart, with the option of repeat treatment at 3 months if clinical response was incomplete. Those randomized to surgery underwent simple elliptical excision with 3-mm margins from the estimated edge of the lesion.

The lesion complete response rate was 87% with MAL-PDT and 89% with excision, confirming the noninferiority of MAL-PDT to surgery, wrote Dr. Szeimies.

Results were similar in the two groups for lesions on the trunk and neck, with MAL-PDT and excision having complete response rates of 85% and 89%, respectively. For lesions on the face and scalp, MAL-PDT and excision showed complete response rates of 95% and 67%.

Complete response was not related to size of the lesion.

Investigator-rated cosmetic outcome favored MAL-PDT, with 87% of lesions having good to excellent outcome, compared with 58% of those in the surgery group.

Patients also preferred the cosmetic outcome with MAL-PDT, with 93% rating the outcome as good to excellent, compared with 81% of the patients in the excision group.

The study was sponsored by Galderma, which makes the MAL-PDT used in the study.

In a recent review of experience with MAL-PDT for basal cell carcinoma, Dr. Szeimies noted that, while surgery remains the preferred method of treatment, some patients—such as those with large lesions, poor vasculature, and concomitant use of anticoagulants or immunosuppressives—may be poor candidates for surgery.

Moreover, postsurgical keloid or dystrophic scarring is common, particularly on the trunk. "Because of the relatively low-risk nature of superficial [basal cell carcinoma], scarring problems should be taken into consideration when choosing a suitable therapy. Therefore, PDT may offer significant advantages over surgical or other destructive techniques" he wrote (Dermatol. Clin. 2007;25:89–94).

Dr. Szeimies disclosed no conflicts of interest.

VIENNA — Treatment with methyl aminolevulinate-photodynamic therapy was as effective as surgery for superficial basal cell carcinoma, Dr. Rolf-Markus Szeimies reported in a poster session at the 16th Congress of the European Academy of Dermatology and Venereology.

Among the methods for removal of basal cell carcinomas are simple excision, Mohs surgery, radiotherapy, curettage/electrodessication, and cryosurgery, with the choice of treatment depending on type, size, depth, and location of the lesion.

Methyl aminolevulinate-photodynamic therapy (MAL-PDT) has previously been shown to be as effective as cryotherapy for removal of these lesions and to have superior cosmetic results. Now, in the first multicenter randomized trial comparing MAL-PDT with simple excision, similar findings have been found, according to Dr. Szeimies of the department of dermatology, Regensburg (Germany) University Hospital.

A total of 196 patients whose mean age was 63.8 years were included in the study. The mean number of lesions per patient was 1.4, and the mean diameter of the lesions was 12.4 mm.

Patients randomized to MAL-PDT underwent two treatment sessions 7 days apart, with the option of repeat treatment at 3 months if clinical response was incomplete. Those randomized to surgery underwent simple elliptical excision with 3-mm margins from the estimated edge of the lesion.

The lesion complete response rate was 87% with MAL-PDT and 89% with excision, confirming the noninferiority of MAL-PDT to surgery, wrote Dr. Szeimies.

Results were similar in the two groups for lesions on the trunk and neck, with MAL-PDT and excision having complete response rates of 85% and 89%, respectively. For lesions on the face and scalp, MAL-PDT and excision showed complete response rates of 95% and 67%.

Complete response was not related to size of the lesion.

Investigator-rated cosmetic outcome favored MAL-PDT, with 87% of lesions having good to excellent outcome, compared with 58% of those in the surgery group.

Patients also preferred the cosmetic outcome with MAL-PDT, with 93% rating the outcome as good to excellent, compared with 81% of the patients in the excision group.

The study was sponsored by Galderma, which makes the MAL-PDT used in the study.

In a recent review of experience with MAL-PDT for basal cell carcinoma, Dr. Szeimies noted that, while surgery remains the preferred method of treatment, some patients—such as those with large lesions, poor vasculature, and concomitant use of anticoagulants or immunosuppressives—may be poor candidates for surgery.

Moreover, postsurgical keloid or dystrophic scarring is common, particularly on the trunk. "Because of the relatively low-risk nature of superficial [basal cell carcinoma], scarring problems should be taken into consideration when choosing a suitable therapy. Therefore, PDT may offer significant advantages over surgical or other destructive techniques" he wrote (Dermatol. Clin. 2007;25:89–94).

Dr. Szeimies disclosed no conflicts of interest.

VIENNA — Treatment with methyl aminolevulinate-photodynamic therapy was as effective as surgery for superficial basal cell carcinoma, Dr. Rolf-Markus Szeimies reported in a poster session at the 16th Congress of the European Academy of Dermatology and Venereology.

Among the methods for removal of basal cell carcinomas are simple excision, Mohs surgery, radiotherapy, curettage/electrodessication, and cryosurgery, with the choice of treatment depending on type, size, depth, and location of the lesion.

Methyl aminolevulinate-photodynamic therapy (MAL-PDT) has previously been shown to be as effective as cryotherapy for removal of these lesions and to have superior cosmetic results. Now, in the first multicenter randomized trial comparing MAL-PDT with simple excision, similar findings have been found, according to Dr. Szeimies of the department of dermatology, Regensburg (Germany) University Hospital.

A total of 196 patients whose mean age was 63.8 years were included in the study. The mean number of lesions per patient was 1.4, and the mean diameter of the lesions was 12.4 mm.

Patients randomized to MAL-PDT underwent two treatment sessions 7 days apart, with the option of repeat treatment at 3 months if clinical response was incomplete. Those randomized to surgery underwent simple elliptical excision with 3-mm margins from the estimated edge of the lesion.

The lesion complete response rate was 87% with MAL-PDT and 89% with excision, confirming the noninferiority of MAL-PDT to surgery, wrote Dr. Szeimies.

Results were similar in the two groups for lesions on the trunk and neck, with MAL-PDT and excision having complete response rates of 85% and 89%, respectively. For lesions on the face and scalp, MAL-PDT and excision showed complete response rates of 95% and 67%.

Complete response was not related to size of the lesion.

Investigator-rated cosmetic outcome favored MAL-PDT, with 87% of lesions having good to excellent outcome, compared with 58% of those in the surgery group.

Patients also preferred the cosmetic outcome with MAL-PDT, with 93% rating the outcome as good to excellent, compared with 81% of the patients in the excision group.

The study was sponsored by Galderma, which makes the MAL-PDT used in the study.

In a recent review of experience with MAL-PDT for basal cell carcinoma, Dr. Szeimies noted that, while surgery remains the preferred method of treatment, some patients—such as those with large lesions, poor vasculature, and concomitant use of anticoagulants or immunosuppressives—may be poor candidates for surgery.

Moreover, postsurgical keloid or dystrophic scarring is common, particularly on the trunk. "Because of the relatively low-risk nature of superficial [basal cell carcinoma], scarring problems should be taken into consideration when choosing a suitable therapy. Therefore, PDT may offer significant advantages over surgical or other destructive techniques" he wrote (Dermatol. Clin. 2007;25:89–94).

Dr. Szeimies disclosed no conflicts of interest.