Photodynamic Therapy in the Management of Nonmelanoma Skin Cancers

Photodynamic therapy involves the use of light to activate a photosensitizer, localized in the diseased skin, resulting in the formation of cytotoxic reactive oxygen species. Topical photodynamic therapy (PDT) is used to treat nonmelanoma skin cancers, such as actinic keratoses, Bowen's disease, and basal cell carcinoma, superficial as well as nodular. This article presents up-to-date, practical recommendations on the use of topical PDT using 5-aminolevulinic acid or methyl aminolevulinate for the treatment as well as 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, tolerability and cosmetic outcome. Most authors concluded that topical PDT was highly effective in the treatment of actinic keratoses, Bowen's disease, superficial and thin nodular basal cell carcinomas, without cosmetic defects usually seen in standard therapeutic procedures. Photodynamic therapy may also be a means of preventing certain nonmelanoma skin cancers in immunosuppressed patients. Acta Medica Medianae 2008;47(2):28-32.