Photodynamic Therapy in the Treatment of Skin Cancer

Dear colleagues,

Non-melanoma skin cancer (NMSC) is the most frequent malignancy. Together with actinic keratosis (AK), the precursors of some NMSCs, they constitute a frequent morbidity, the so-called field cancerization. Visible skin lesions are only a small part of the overall sun-damage, where AK may already exist. Field cancerization is the presence of precancerous and dysplastic lesions distributed over an area of skin, often too large to allow for radical surgical removal.

Methods that selectively and specifically target NMSC, including precancerous changes that are not yet visible clinically, are the most efficient measures for preventing skin cancer and its complications. Photodynamic therapy (PDT) is a suitable treatment and preventive option for any patient with long-term sun exposure, with or without visible changes in the skin.

Treatments for field cancerization are especially valuable in immunosuppressed patients who develop more numerous and aggressive NMSC. Organ transplant recipients are at a significantly higher risk for developing metastatic NMSC. PDT, as a preventive measure in this patient group, has been shown to be successful—reducing and postponing the appearance of precancer and cancer. Established lesions may be suitable for PDT or be treated separately while “cleaning” the rest of the “cancer field” with PDT.

PDT is a topical non-surgical technique where a photosensitizing agent is applied and accumulates in target cells, and when the photosensitizer absorbs light, it is photochemically activated. The light then becomes toxic to the cells that have ingested more photosensitizer. Precancerous and cancerous cells divide more often and accumulate the photosensitizer more rapidly than healthy cells, rendering them vulnerable to light. After an appropriate time period, all unhealthy cells will have enough sensitizer to be destroyed, while healthy cells are not vulnerable.

Our strategy is to continuously improve the efficacy and to reduce the side effects of PDT for the most optimal patient care.

Dr. Flora N. Balieva
Guest Editor

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