Photodynamic therapy for Bowen's disease and squamous cell carcinoma of the skin

Background: Photodynamic therapy involves the activation by visible light of a previously administered photosensitizing agent in order to cause tumor necrosis. Skin tumors can be treated with topical photosensitizers and thus avoiding systemic side effects. In this study we evaluate the immediate and long-term effects of photodynamic therapy (PDT), using aminolevulinic acid (ALA) as a photosensitizer and a non-laser light source, on Bowen's disease (intra-epithelial squamous cell carcinoma) and on frank squamous cell carcinoma (SCC) of the skin. Methods: ALA in cream form (20%) was topically applied on biopsy-proven Bowen's disease or SCC of the skin. The lesions were covered with occlusive and light-shielding dressing. Sixteen hours later, they were submitted to a 10-min light session using Versa-Light™, a non-laser light source (spectral output of 580-720 nm and 1250-1600 nm, 100 J/cm²). The initial evaluation was done 21 days post-treatment and every 3 m thereafter. Patients that did not respond to treatment after two to three sessions were referred to surgery. Results: Forty Bowen's disease lesions (24 patients) and 43 SCC lesions (18 patients) underwent treatment. Median follow-up was 21 ± 8 m. No patient had any remarkable side effects. Thirty-four Bowen's disease (85%) lesions completely responded as did 32 SCC lesions (74%). Conclusions: Our findings showed that PDT is highly effective in treating Bowen's disease and SCC lesions and can be used as a first treatment modality in so far as its use does not preclude the subsequent surgery recommended for the small percentage of failures.