[en] Photodynamic therapy (PDT) and topical imiquimod immunotherapy (TII) are two recently introduced treatment modalities for certain types of basal cell carcinomas (BCC). We present a review of the relevant literature and report our own findings regarding the efficacy and tolerance of PDT and TII in the treatment of BCCs. According to published studies, the cure rates range from 75-95% for PDT and 42-100% for TII, depending on treatment modalities and BCC type. In our observations, 13 patients with nodular or superficial BCCs were treated by PDT using two courses of 3-hour topical application of methyl aminolevulinate, followed by 8 minutes illumination (lambda = 634 rim, e = 37J/cm(2)). Biopsies were taken before and one month after PDT. Side effects including pain and crusting were assessed. Eight patients with superficial BCC were treated by TII using 3 monthly courses each consisting of 3 weekly applications for 3 weeks followed by one week out of treatment. Biopsies were taken before and after 3 months of TII. Adverse reactions including erythema, oozing, ulceration, and crusting were recorded. Clinico-histological cure was obtained in 12/13 PDT cases as assessed after I month, and in 6/8 TII cases after 3 months. Minimal pain during illumination and crust formation were observed in 7/13 and 3/13 PDT cases, respectively. Variable erythema, oozing, ulceration, and crusting were observed in all TII-treated lesions. It is concluded that PDT represents an active and well tolerated alternative treatment for both nodular and superficial BCCs. TII also shows activity, although the tolerance may be poor and cure needs a longer time to be obtained. The final cosmetic appearance was fine following both PDT and TII procedures. Both PDT and TII may leave intact neoplastic aggregates inside the skin. They cannot be clinically perceived, leading to unexpected recurrences. It is stressed that the currently available efficacy information about PDT and TII deals with short term follow-up periods. A 5-year follow-up must be awaited before drawing firm conclusions.
Disciplines :
Dermatology
Author, co-author :
Nikkels, Arjen ; Université de Liège - ULiège > Dermatologie
Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United States: incidence. J Am Acad Dermatol. 1994;30:774-8.
Marks R, Motley RJ. Skin cancer. Recognition and treatment. Drugs. 1995;50:48-61.
Piérard-Franchimont C, Uhoda I, Piérard GE. Cutaneous cancers in the Mosan region and Ardennes of Belgium. Dermatology. 1999;198:187-91.
Uhoda I, Quatresooz P, Fumal I, et al. Updating trends in cutaneous cancers in south east Belgium. Oncol Reports. 2004;12: 111-4.
Fleming ID, Amonette R, Monaghan T, Fleming MD. Principles of management of basal and squamous cell carcinoma of the skin. Cancer. 1995;75:S699-704.
Kuijpers DI, Thissen MR, Neumann MH. Basal cell carcinoma: treatment options and prognosis, a scientific approach to a common malignancy. Am J Clin Dermatol. 2002;3:247-59.
Nikkels AF, Piérard GE. Une tumeur du cuir chevelu révélatrice d'une naevomatose basocellulaire. Rev Med Liège. 2002;57: 185-6.
Wolfe JT. The role of screening in the management of skin cancer. Curr Opin Oncol. 1999;11:123-8.
MacKie RM. Awareness, knowledge and attitudes to basal cell carcinoma and actinic keratoses among general public within Europe. J Eur Acad Dermatol Venereol. 2004;18:552-5.
Nikkels AF, Nikkels-Tassoudji N, Jerusalem-Noury E, et al. Skin cancer screening campaign in the German speaking community of Belgium. Acta Clin Belg. 2004;59:194-8.
Piérard GE, Piérard-Franchimont C, Cornil F, et al. Relativité de la prise en charge des cancers cutanés. Plaidoyer pour la synergie entre le médecin généraliste et le dermatologue-oncologue. Rev Med Liège. 2000;55:247-52.
Oleinick NL, Evans HH. The photobiology of photodynamic therapy: cellular targets and mechanisms. Radiation Research 1998;150:8146-56.
Soler AM, Warloe T, Tausjo J, et al. Photodynamic therapy by topical aminolevulinic acid, dimethylsulphoxide and curetage in nodular basal cell carcinoma: one-year follow-up study. Acta Derm Venereol. 1999;79:204-6.
Morton CA, Whitehurst C, McColl J, et al. Photodynamic therapy for large or multiple patches of bowen disease and basal cell carcinoma. Arch Dermatol. 2001;137:319-24.
Wennberg AM, Wulf HC, Warloe T, et al. Metvix photodynamic therapy in patients with basal cell carcinoma at risk of complications and poor cosmetic outcome after conventional therapy. J Eur Acad Dermatol Venereol. 2001;15:225-8.
Foley P. Clinical efficacy of methyl aminolevulinate (metvix®) photodynamic therapy. J Dermatol Treatment. 2003;14:S15-S22.
Horn M, Wolf P, Wulf HC, et al. Topical methyl aminolaevulinate photodynamic therapy in patients with basal cell carcinoma prone to complications and poor cosmetic outcome with conventional treatment. Br J Dermatol. 2003;149:1242-9.
Rhodes LE, De Rie M, Enstrom Y, et al. Photodynamic therapy using topical methyl aminolevulinate vs surgery for nodular basal cell carcinoma. Arch Dermatol. 2004;140:17-23.
Testerman TL, Gerster JF, Imbertson ML, et al. Cytokine induction by the immunomodulators imiquimod and S-27609. L Leukoc Biol. 1995;58:365-72.
Wagner TL, Ahonen CL, Couture AM, et al. Modulation of Th1 and Th2 cytokine production with the immune response modifiers, R-848 and imiquimod. Cell Immunol 1999;191:10-9.
Hermanns-Le T, Nikkels AF, Uhoda I, et al. L'imiquimod (Aldara). Un immunomodulateur pour la peau. Rev Med Liege. 2002;57:116-8.
Habets JMW, Tank B, Vuzevski VD et al. Characterization of the mononuclear infiltrate in basal cell carcinomas predominantly T cell mediated immune response with minor part of Leu-7+ (natural killer) cells and Leu-14+ (B) cells. J Invest Dermatol. 1988;90:289-92.
Markey AC, Churchill LJ, Allen MH, MacDonald DM. Activation and inducer subset phenotype of the lymphocytic infiltrate around epidermally derived tumors. J Am Acad Dermatol. 1990;23:214-22.
Hunt MJ, Halliday GM, Weedon D, et al. Regression in basal cell carcinoma: an immunohistochemical analysis. Br J Dermatol. 1994;130:1-8.
Beutner KR, Geisse JR, Helman D, et al. Therapeutic response of basal cell carcinoma to the immune response modifier imiquimod 5% cream. J Am Acad Dermatol. 1999;41:1002-7.
Beutner KR, Spruance SL, Hougham AJ. Treatment of genital warts with an immune response modifier (imiquimod). J Acad Am Dermatol. 1998;38:230-9.
Shumack S, Robienson J, Kossard S, et al. Efficacy of topical 5% Imiquimod cream for the treatment of nodular basal cell carcinoma. Arch Dermatol. 2002;138:1165-71.
Sterry W, Herrera E, Takwale A, et al. Imiquimod 5 cream for treatment of superficial and nodular basal cell carcinoma: randomized studies comparing low-frequency dosing with and without occlusion. Br J Dermatol. 2002;147:1227-36.
Geisse JK, Rich P, Pandya A, et al. Imiquimod 5% cream for the treatement of superficial basal cell carcinoma: a double blind, vehicle controlled study. J Am Acad Dermatol. 2002;47:390-8.
Marks R, Gebauer K, Shumack S, et al. Imiquimod 5% cream in the treatment of superficial basal cell carcinoma: result of a multicenter 6-week dose-reponse trial. J Am Acad Dermatol. 2001;44:807-13.
Marks R, Owens M, Walters SA, et al. Efficacy and safety of 5% imiquimod cream in the treating patients with multiple superficial basal cell carcinomas. Arch Dermatol. 2004;140: 1284-5.
Piérard-Franchimont C, Nikkels AF, Paquet P, et al. Comment je traite un carcinome basocellulaire par l'imiquimod topique (Aldara®). Rev Med Liège, in press.
Bourguignon R, Paquet P, Quatresooz P, Piérard GE. Comment je traite, un lentigo malin par l'imiquimod topique. Rev Med Liège. In press.
Zitelli JA. Use of imiquimod for treating skin cancers. J Am Acad Dermatol. 2005;52:177.
Arrese JE, Paquet P, Claessens N, et al. Dermal dendritic cells in anogenital warty lesions unresponsive to an immune-response modifier. J Cutan Pathol. 2001;28:131-4.
Hermanns-Le T, Paquet P, Nikkels AF, et al. Histological mimicry in the skin infiltration pattern of the monocyte-macrophage dendrocyte lineage during prolonged imiquimod treatment and graft versus host reaction. Dermatology. 2003;206:361-5.