Photodynamic Therapy (PDT) is an effective treatment for some non-melanoma skin cancers as well as certain types of pre-cancerous lesions, such as actinic/solar keratoses.
Not all lesions are suitable for this treatment and therefore it will only be offered in particular circumstances.
How does Photodynamic Therapy work?
Photodynamic Therapy (PDT) is a simple, non-invasive treatment that consists of the application of an activating cream to the lesion(s) followed by exposure to a particular light source (633nm red LED). The abnormal cells in the lesion absorb the active ingredient from the cream. When exposed to the red light, a chemical reaction occurs which destroys those cells, minimising side effects and the potential for scarring.
What does Photodynamic Therapy involve?
Prior to commencing this treatment, a biopsy will need to be performed to confirm the diagnosis. You may have more than one lesion treated at one time. PDT treatment consists of the following steps.
Before the activating cream is applied, the lesion(s) will be prepared by removing any scale/crust and roughening the skin surface. This preparation phase allows the cream to be maximally absorbed by the abnormal cells that cause the lesions.
The cream will then be applied to the lesion and the adjacent skin. This area will then be covered with a dressing, which must remain in place for 2-3 hours. During this time you are free to leave the Clinic, however you must ensure that the lesion is not exposed to very cold air or to direct sunlight.
We use a 633nm red light source from the Healite II lamp for the activation phase. The dressing is removed and the treated area cleansed and then immediately exposed to the red light for a short period of around 10 minutes.This process is called “illumination”. Due to the selective nature of the cream, healthy skin surrounding the lesion does not need to be protected during illumination. You will be given safety goggles to protect your eyes during the illumination as the light is very intense. The number of treatments that you will need depends upon the type of lesion that you have. Your doctor will discuss this with you and will also ask you to return for a check-up after 3 months.
Application of a healing balm and SPF cream
Not everyone experiences pain, and in most cases PDT is very well tolerated. You may experience a stinging or burning sensation during the illumination phase. If the treatment becomes uncomfortable, the light can be paused for a short time to relieve any discomfort. It is possible to use local anaesthetic and/or nerve blocks to alleviate any pain if PDT is being performed over large areas.
After your treatment you will be advised to keep the treated area clean. Due to the sunsensitivity of photodynamic therapy, many patients have a sunburn feeling for several days following treatment. This can be alleviated with the use of cool compresses, and it is recommended that you protect the treated skin from direct sunlight whilst it is healing. Local discomfort around the treatment site is the most common side effect with PDT. Mild to moderate redness, swelling and inflammation are normal after-treatment responses, which usually resolve rapidly. Large treatment areas such as the face or scalp usually heal within 4-6 days. If you have PDT to the lower limbs, you may need to restrict your activities for a few extra days to ensure that your skin heals.
Costs of photodynamic therapy will depend on the area treated and the number of sessions you will require.
Actinic/solar keratoses (sunspots) will require only one treatment session, whilst skin cancers will require two sessions. Our doctor will assess the severity and area at the time of consultation.
Note: PDT is NOT covered under Medicare. Some health insurance companies do provide a partial rebate for this procedure. We advise patients to check with their cover prior to undertaking this procedure.
In general Photodynamic Therapy treatment has:
- Potentially less scarring compared to surgery
- Less down time
- Quicker recovery (typically days, not weeks/months)
- Photorejuvenation effects if used on sunspots or sun damaged skin
Recent studies have indicated that field treatment with PDT is the most effective of the current options available for treating actinic/solar keratoses when compared to cryotherapy (freezing) and topical prescription creams.
Note that not all lesions are suitable for PDT, and therefore it will only be offered in appropriate circumstances.
*UPDATE* As of May 2015
The Australasian College of Dermatologists have published a consensus statement on the use of “Daylight PDT”:
“Daylight photodynamic therapy (PDT) is emerging as an efficacious treatment for AK, particularly for patients who require treatment of large areas of chronic actinic damage that can be exposed easily to daylight. Daylight PDT with methyl aminolevulinate (MAL) cream is a simple treatment for AK, almost painless, well tolerated and convenient, requiring minimal time in the clinic. Randomised controlled studies from northern Europe and Australia support the use of daylight PDT as an effective therapy for grade I and II AK on the face and scalp. There is sufficient daylight to conduct daylight PDT in Australia at any time of the year and during most weather conditions. Hence, daylight PDT with MAL can be included as an effective and well-tolerated new treatment option for the treatment of AK in Australia.“
*Consensus recommendations on the use of daylight photodynamic therapy with methyl aminolevulinate cream for actinic keratoses in Australia See JA et al Australas J Dermatol. 2015 May 31. doi: 10.1111/ajd.12354.