Basal cell carcinoma treated successfully with combined CO2 laser and photodynamic therapy in a renal transplant patient: a case report

Renal transplant recipients are at significantly greater risk of developing skin malignancies due to combination immunosuppressive therapy. A significant number of patients present with lesions needing excision at multiple outpatient follow-up visits. For basal cell carcinoma, we have recently described how combining CO(2) laser with Photodynamic therapy greatly increases the efficacy of long-term tumour clearance compared with each modality alone. We present a case of a 66-year-old renal transplant therapy patient who repeatedly presents with new skin malignancies, in whom we treated successfully with Laser-Photodynamic therapy in a see-and-treat setting. This therapy offers patients the possibility of better cosmetic and functional results whilst obviating the need for repeated surgery. Other pre-cancerous lesions such as solar keratoses are prevalent in this patient group and respond extremely well to Photodynamic therapy monotherapy. We propose a regular clinic for renal transplant patients in a laser facility equipped with CO(2) laser and Photodynamic therapy, histopathology and punch-biopsy materials. This strategy allows simple and effective treatment of multiple lesions simultaneously, avoidance of numerous operations, avoidance of non-essential outpatient appointments that result in booking furthers visits for treatment, whilst facilitating diagnostic biopsies of potentially malignant lesions. We outline a care pathway for a see-and-treat clinic that implements this novel treatment modality improving the care of this unique patient population.