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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

DOI: 10.1155/2011/240340

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Abstract:

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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