Shokrollahi Kayvan, Javed Mohammed, Aeuyung Karen, Ghattaura Amar, Whitaker Iain S, O'Leary Barbara, James William, Murison Maxwell
From the *Welsh Regional Burns and Plastic Surgery Unit, Morriston Hospital, Swansea; and †Mersey Regional Burns and Plastic Surgery Unit, Whiston Hospital, Merseyside, UK.
Ann Plast Surg. 2014 Nov;73(5):552-8. doi: 10.1097/SAP.0b013e3182773ed2.
Basal cell carcinomas (BCCs) are often seen by general practitioners, plastic surgeons, and dermatologists in the outpatient setting. Photodynamic therapy (PDT) and CO2 laser when used as monotherapy have been successfully used to treat small BCC, with greatest success in the superficial histological subtype but have limitations compared to surgical excision due to a limited depth of penetration of PDT (2 mm absorption) limiting efficacy. We describe our experience of dual-modality treatment improving efficacy, cosmetic outcomes, and minimizing recurrence.
One hundred ten patients with a total of 177 lesions mainly on the head and neck were treated with combined therapy using an UltraPulse CO2 laser and PDT using methyl aminolevulinate (METVIX) at the same sitting, with repeat PDT 1 week later. We evaluated recurrences, cosmetic outcomes, patient satisfaction, and costs.
The mean age of patients was 67 years. The mean follow-up period was 32.2 months, with a range of 7.7 to 68.5 months. Eighty six lesions were followed up for more than 3 years. A total of 177 lesions were diagnosed and treated. Only biopsy-proven BCCs were included in this study. Histologically, 34 (19.2%) were superficial subtype, 50 (28.2%) nodular, 9 (5.08%) infiltrative, 7 (3.95%) morpheic, 3 (1.69%) mixed, and in 74 (41.8%) diagnosis was simply BCC. All lesions responded to treatment as assessed by clinical evaluation with regular follow-up. The total recurrence-free rate was 97.1%. In 88.1% lesions, a single cycle of treatment was required; 9.03% had 2 cycles and 0.56% underwent 3 cycles. In 3 of the patients, no data were available. Recurrences were noted in 5 (2.82%) cases. All recurrences were treated successfully, all but one using repeat laser-PDT. One patient underwent surgical excision. No significant complications were encountered, although mild hypopigmentation was occasionally seen and some discomfort is experienced with PDT.
Combined CO2 laser and PDT have equivalent cure rates to surgery for BCCs--notably of the nodular subtype--these modalities acting synergistically. This strategy provides cure often with scarless outcomes as illustrated. Laser with PDT is most appropriate for patients who value excellent cosmetic outcomes and where avoidance of an invasive procedure is an important factor. In addition, this modality comes into its own for specific groups of patients, such as those on Warfarin or those with diffuse or multiple lesions.
全科医生、整形外科医生和皮肤科医生在门诊环境中经常会遇到基底细胞癌（BCC）患者。光动力疗法（PDT）和二氧化碳激光作为单一疗法已成功用于治疗小型BCC，在浅表组织学亚型中取得了最大成功，但与手术切除相比存在局限性，因为PDT的穿透深度有限（吸收2毫米）限制了疗效。我们描述了我们采用双模式治疗提高疗效、改善美容效果并将复发率降至最低的经验。
110例患者共177个主要位于头颈部的病灶，在同一次就诊时采用超脉冲二氧化碳激光和使用甲基氨基乙酰丙酸（METVIX）的PDT联合治疗，1周后重复进行PDT。我们评估了复发情况、美容效果、患者满意度和成本。
患者的平均年龄为67岁。平均随访期为32.2个月，范围为7.7至68.5个月。86个病灶随访超过3年。总共诊断并治疗了177个病灶。本研究仅纳入经活检证实的BCC。组织学上，34个（19.2%）为浅表亚型，50个（28.2%）为结节型，9个（5.08%）为浸润型，7个（3.95%）为硬斑病样型，3个（1.69%）为混合型，74个（41.8%）仅诊断为BCC。通过定期随访的临床评估，所有病灶对治疗均有反应。总无复发率为97.1%。88.1%的病灶只需一个疗程的治疗；9.03%需要2个疗程，0.56%接受了3个疗程。3例患者无可用数据。5例（2.82%）出现复发。所有复发均成功治疗，除1例采用重复激光 - PDT治疗外，其余均采用手术切除。未遇到重大并发症，尽管偶尔可见轻度色素减退，且PDT会带来一些不适。
二氧化碳激光和PDT联合治疗BCC的治愈率与手术相当——尤其是结节型——这些方法具有协同作用。如所示，这种策略通常能实现无瘢痕治愈。激光联合PDT最适合那些重视出色美容效果且避免侵入性手术是重要因素的患者。此外，这种治疗方式对于特定患者群体，如服用华法林的患者或有弥漫性或多发性病灶的患者特别适用。
