Combined CO(2) Laser with Photodynamic Therapy for the Treatment of Nodular Basal Cell Carcinomas

Background: Basal cell carcinomas (BCC) are often seen by plastic surgeons and dermatologists in the outpatient setting. Treatment usually necessitates excision of these lesions with an appropriate margin guided by published recommendations, often resulting in less than ideal cosmetic outcomes, especially if local flaps or skin grafts are required for reconstruction. Photodynamic therapy (PDT) and CO(2) laser when used as monotherapy have been successfully used to treat BCCs, with greatest success in the superficial histologic subtype. These modalities when used alone have a number of limitations when compared with surgical excision, including a limited depth of penetration of PDT (2-mm absorption), which potentially limits the efficacy of treatment of nodular BCCs greater than this thickness or which are deeply invasive. We describe our positive experiences of combination therapy with both modalities in 12 patients, with the aim of improving treatment efficacy.

Methods: Twelve patients with 13 biopsy-proven nodular BCCs on the head and neck were treated with combined therapy using an Ultra Pulse CO(2) and PDT using Methyl Aminolevulinate (METVIX) and the Aktilite 16 LED lamp.

Results: A total of 12 patients (13 lesions) were treated using combined CO(2) laser/PDT. Nine were male and 2 female; 1 had gender reassignment. The mean age was 67, with a range of 54 to 85. The mean follow-up period was 18.1 months, with a range of 7 to 26 months. All lesions responded to treatment as assessed by clinical evaluation, with regular follow-up on a 3-month basis. There were no recurrences during this time period. The only complications encountered were mild hypopigmentation in 2 cases and mild discomfort experienced with PDT.

Conclusion: In this study, CO(2) laser and PDT appear to play a synergistic role in the treatment of nodular basal cell carcinomas. Both the surgical team and the patients have been pleased with the results. The mean recurrence-free follow-up was 18.1 months. This apparently synergistic treatment appears most appropriate for patients who value excellent cosmetic outcome over the inconvenience of making additional visits to the clinic or where avoidance of an invasive procedure is an important factor.