Keratinocyte Cancer

Aim: Conventional photodynamic treatment of thin BCCs has uncomfortably high rates of incomplete clearance.Incomplete clearance rates for superficial tumours are as high as 40% and even higher for tumours on the head and neck.Our experience is that flushing is more pronounced on the head and neck during photoactivation.We postulated that haemoglobin, although it may provide oxygen, may also be acting as a competing chromophore.Our objective was to determine whether a 2-phased photoactivation protocol, in which the first phase consists of conventional red-light activation (20-37 Jcm -2 ), and second phase photoactivation uses intense pulsed light (IPL, 30-45 Jcm -2 total) delivered with sufficient mechanical pressure in the handpiece to blanch the skin, improves clearance rates.Method: Retrospective observational study of 206 nonrecurrent BCCs 1 mm depth treated over a 7-year period with a 2-phased photoactivation protocol ("biphasic PDT").For the IPL phase, a cut-off filter in the 515-560 nm range has been used.The pulse-width is set at 100 ms to mitigate photothermal effects of the IPL.Tumours had one or two biphasic treatments.Optical coherence tomography (OCT) has been used to aid in the diagnosis, to establish suitability of tumours for treatment, and to aid in verifying treatment outcomes.Result: In the final group of 178 tumours, of which 77 were nodular and/or superficially infiltrating, 109 were located on the head and neck including 43 tumours on noses, there were 4 incomplete treatments over a 2-year median follow-up period (up to 7 years).This represents a clearance rate of 98%. Conclusion:One or two biphasic photodynamic treatments were highly effective in a large group of thin BCCs that were selected on features identified on clinical and OCT assessment.This included many nodular BCCs on faces and noses, and some with infiltrating features.The few incomplete clearances were easily managed.