Pre-Treatment Deep Curettage Can Significantly Reduce Tumour Thickness in Thick Basal Cell Carcinoma While Maintaining a Favourable Cosmetic Outcome When Used in Combination with Topical Photodynamic Therapy
Topical photodynamic therapy (PDT) has limitations in the treatment of thick skin tumours. The aim of the study was to evaluate the effect of pre-PDT deep curettage on tumour thickness in thick (≥2？mm) basal cell carcinoma (BCC). Additionally, 3-month treatment outcome and change of tumour thickness from diagnosis to treatment were investigated. At diagnosis, mean tumour thickness was 2.3？mm (range 2.0–4.0). Pre- and post-curettage biopsies were taken from each tumour prior to PDT. Of 32 verified BCCs, tumour thickness was reduced by 50% after deep curettage . Mean tumour thickness was also reduced from diagnosis to treatment. At 3-month followup, complete tumour response was found in 93% and the cosmetic outcome was rated excellent or good in 100% of cases. In conclusion, deep curettage significantly reduces BCC thickness and may with topical PDT provide a favourable clinical and cosmetic short-term outcome. 1. Introduction Basal cell carcinoma (BCC) is the most common cancer in the white population, and its incidence is still increasing [1, 2]. This is a slow-growing, locally invasive epidermal skin tumour that can cause considerable patient morbidity [3, 4]. BCC most often arises on sun exposed, cosmetic sensitive skin areas such as the face [4]. Among several therapeutic options available for the treatment of this tumour excision surgery is regarded as the most effective [5]. However, not all patients are qualified for surgery. Excision surgery may be challenging in certain anatomic areas, cause cosmetic disfigurement, or result in complications like scar formation and functional impairment [6]. Topical PDT, with beneficial cosmesis, may in such cases be an attractive treatment option [7, 8]. This method involves the activation of a topically applied photosensitizer by light in the presence of tissue oxygen, starting a photochemical reaction in the targeted cells [9]. Five-year clearance rates in BCC from 64 to 81% are reported [10–13]. Evidence-based guidelines support the use of topical PDT in the treatment of BCC, particularly low risk, superficial lesions [14, 15]. A challenge is the limited penetration of the photosensitizing agents down to about 1.0 to 2.0？mm depth [16–18] and also limitation of red light to penetrate the skin [9]. The treatment efficacy in BCC with thickness ≥2.0？mm may therefore be reduced. Among several strategies to increase PDT effect, pre-treatment curettage has been shown to improve treatment efficacy in nodular tumours [19]. The combination of curettage ahead of PDT is today commonly used, even though data to supports
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