Mr. Andy Pay FRCS (Plast), Consultant Plastic Surgeon
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Sometimes if the diagnostic biopsy confirms a suitable lesion (usually superficial less than 1mm thick) then it may be possible to treat the lesion with PDT. A sensitising oitnment is applied to the lesion and after a short period of time a special (blue) light is shone directly onto the lesion for 8 to 10 minutes. Because this is occasionally uncomfortable, sometimes a local anaesthetic cream can be applied to the area treated. This treatment can only be done in a department (usually Dermatology) which has the appropriate equipment and trained personnel for it’s use.
This is focused XRay therapy, targeted at the lesion in question. In order to be considered for this treatment, a diagnostic biopsy is required, which means that in many cases where a simple excision biopsy is possible, then Surgery is clearly the better option. Nevertheless, it is an extremely useful treatment in selected cases where surgery may not necessarily be possible or preferred due to size, anatomical site or patient factors etc.
The treatment occurs over a number of separate outpatient sessions (usually 6 to 8) spread out over a couple of weeks.The treatment is not painful but towards the end of the therapy regime the area may become red and sore (a little bit like a sunburn!). The area then tends to scab and crust over a few weeks and then heals up, generally leaving a small pale patch at the site of the treated area. The advantage is that an operation can be avoided, therefore avoiding surgical scarring and the potential for tissue distortion is considerably reduced. The cure rate for BCCs and SCCs (it isnt generally used for treatment in primary Melanoma) is of the order of 90 to 95%.
Because some BCCs are superficial, it is possible to use cryotherapy in the form of liquid Nitrogen to treat them. The principle is that the therapy produces a controlled injury of the skin at a superficial level, which causes the top surface layer of the skin to come away in the form of a blister, thus taking the superficial lesion with it. The area scabs, crusts and heals naturally over a few weeks. Occasionally a simple dressing is required for a short time whilst the area settles. Sometimes more than one treatment is required. This treatment is often used for other skin lesions such as localised areas of sundamaged skin (Actinic Keratoses) and very occasionally for the treatment of small SCCs, where this is the most suitable treatment considering other patient factors (extreme age/unsuitability for other therapies)