Actinic keratoses Non-melanoma skin cancer and Photodynamic therapy Dr Lucy Ostlere
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Actinic keratoses
Non-melanoma skin cancer
and
Photodynamic therapy
Dr Lucy Ostlere
Actinic keratoses
18.6M new cases/year in USA, Australia
and Europe
< 1% SCC
Treatment of actinic keratoses
No treatment
Cryotherapy
Solaraze gel
5-fluorouracil (Efudix)
5% imiquimod (Aldara)
Actikerall
Picato
Actinic keratoses
Pre- efudix 1 week post-efudix
Picato
Non-melanoma skin cancer
(BCC and SCC)
9 out of 10 skin cancer (>85% BCC)
62,000 new cases / year in UK
Incidence increasing by 5% / year
40% chance of 2nd NMSC within 5 years
Squamous cell
carcinoma
Treatment of SCC
Excision
Radiotherapy
Nodular and superficial BCC
Treatment of nodular bccs
Excision
Curettage and hyfrecation x 3
Radiotherapy
Morphoeic BCC
Treatment of morphoeic BCC
Excision +/- Mohs’ micrographic
surgery
Radiotherapy
Superficial BCC
Bowen’s disease
Non-surgical treatment of
superficial BCCs and Bowens
Cryotherapy
5% Imiquimod
Photodynamic therapy
Not suitable for BCCs on face
and lower leg
BCCs 30 secs x 2
Bowen’s 15 secs
Risk of post-inflammatory
hypopigmentation
Cryotherapy for superficial BCCs and Bowen’s disease
Case- Superficial BCC
Treatment with Imiquimod
Post- treatment
Photodynamic therapy
Light
Photo-
sensitiser
O2 O2
O2
O2
O2
ROS
Methylaminolaevulinate (MAL)
Light
Protoporphyrin IX + ROS
Destruction of abnormal cells
Photodynamic therapy
For superficial BCCs, Bowen’s disease
and actinic keratoses (rarely)
Excellent cosmetic result
Response rate of around 90% for
superficial BCCs
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