Abstract :
[en] Background : Besides actinic keratosis, Bowen's disease, as well as superficial and small nodular basal cell carcinoma, aminolevulinic acid and methylaminolevulinic acid photodynamic therapy (ALA-PDT, MAL-PDT) present a broad potential of experimental indications in oncologic skin conditions. AIM : To present the various off-label indications with their respective PDT protocols, treatment results, level of evidence (A, B, C, D levels), and potential clinical interest. MATERIAL AND METHODS : A Pubmed search matched PDT with actinic cheilitis, anal, vulvar, and penile intraepithelial neoplasia (AIN, VIN, PIN), verrucous carcinoma, Paget disease, extramammary Paget disease, cutaneous B-cell lymphoma (CBCL), cutaneous T-cell lymphoma (CTCL), and cutaneous metastases of breast carcinoma. RESULTS : All indications presented interesting complete and partial cures, even in cases faling on previous standard treatments. All publications score C and D levels of evidence. The best PDT outcomes and the lowest recurrence rates concerned unifocal oncologic skin conditions with limited extension. Direct comparison of treatment data was difficult, as PDT protocols were highly variable. Comparative therapeutic trials vs standard care were rarely available. CONCLUSION : PDT represents a valuable treatment alternative in selected off-label oncologic skin conditions. However, literature data are too limited to support a hierarchic treatment position for PDT or a preferential protocol in these specific indications. There is a clear need for clinical trials evaluationg PDT vs standard treatments. In contrast to the approved PDT indications, where clinical evaluation accurately matches histologica evaluation, histology is required in these off- label indications to ensure treatment efficacy. Off-label use of PDT should be measured against the advantages and inconveniencies of standar treatment procedures.
