Artikel
Photodynamic therapy: an organ preserving treatment option for nose and auricle skin tumors
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Autoren
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Gilles Weidig
- Klinikum Mutterhaus der Borromäerinnen Trier, Trier, Germany
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Peter Kress
- Klinikum Mutterhaus der Borromäerinnen Trier, Trier, Germany
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Daniel Neuberger
- Klinikum Mutterhaus der Borromäerinnen Trier, Trier, Germany
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Peter Schwerdtfeger
- Klinikum Mutterhaus der Borromäerinnen Trier, Trier, Germany
| Veröffentlicht: | 22. Juli 2009 |
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Gliederung
Text
Introduction: The surgical treatment of extensive, superficial skin tumors such as actinic keratoses, basal cell carcinomas and Bowen's diseases of the nose and auricle in many cases leads to partial or total ablation of these organs.
Standardized photodynamic therapy with methyl aminolevulinate (MAL) is a potent treatment option with an excellent cosmetic and functional outcome for non-melanoma skin cancers and has a tumor control rate similar to surgical therapy.
Therefore we use topic PDT with MAL to treat extensive, superficial skin tumors especially to avoid partial ablation of the auricle and nose as demonstrated by the clinical example displayed in this poster.
Method: A male 85 years old patient with a recurrent carcinoma in situ of the dorsal auricle and multiple bowenoid lesions of the ventral auricle was treated with standardized topic MAL-PDT (Metvix®). (see Figure 1 [Fig. 1] and 2 [Fig. 2])
After removal of superficial scales and crusts, the tumor site was incubated with MAL-cream under occlusion for 3h.
After three hours the cream excess was gently removed and the photosensitizer was activated with monochromatic red light (654 nm) with a light dose of 37 J/cm2 (Actilight®). The ventral auricle was treated three times, the posterior auricle two times, at intervals of one week. Clinical follow up included microscopic examinations and photo documentation of the treated skin after 4 weeks, 3 months and 6 months.
Results: The first follow up examination after 4 weeks showed complete remission of both tumors . Scares defects or deformation of the auricle were not seen. A tumor recurrence did not appear until today (2 years) (see Figure 3 [Fig. 3] and 4 [Fig. 4]).
Conclusion: In selected cases standardized topic photodynamic therapy with MAL is a reliable, effective and organ preserving treatment option. Therefore PDT should be considered as a therapeutic alternative if surgical treatment would require total or partial ablation of nose or auricle.
PDT should amend the therapeutic repertoire of any plastic surgeon.
