First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Eur Acad Dermatol Venereol. 2017 Aug;31(8):1303-1307. doi: 10.1111/jdv.14177. Epub 2017 Mar 13.
Individuals with medical history of non-melanoma skin cancers (NMSCs) usually develop multiple and/or recurrent malignant lesions around the site of the primary neoplasm. The latter represents the clinical expression of the 'field cancerization' theory; supporting the presence of multiple malignant clones of dysplastic keratinocytes over the entire epithelium that potentially can progress into clinical lesions. Taking into consideration that the burden of NMSCs on public health and health-care cost is high, adequate control of recurrences and management of field change is challenging.
To compare the safety and efficacy of daylight photodynamic therapy (DL-PDT) vs. conventional photodynamic therapy (C-PDT) in the prevention of occurrence of new NMSCs in patients with clinical and histological signs of actinic field damage.
Twenty-six patients, with personal history of NMSCs on the face or scalp and actinic keratosis (AK) on the same fields, were randomized for DL-PDT on one side and C-PDT on the other. For a 12-month period, individuals were clinically evaluated for development of new NMSCs.
The total number of new AKs and the mean time of their development did not significantly differ between the treated sides. Local adverse events were more intense with C-PDT, and patients' preference was more for DL-PDT compared to C-PDT.
The current findings suggest equal preventive potential of DL-PDT vs. C-PDT against the formation of new NMSCs in patients exhibiting actinic field damage.
有非黑色素瘤皮肤癌（NMSC）病史的个体通常在原发性肿瘤部位周围发生多个和/或复发性恶性病变。后者代表了“癌前病变区域化”理论的临床表达；支持整个上皮中存在多个具有异型性的角朊细胞恶性克隆，这些克隆有可能进展为临床病变。考虑到 NMSC 给公共卫生和医疗保健成本带来的负担很高，因此控制复发和管理癌前病变具有挑战性。
比较日光光动力疗法（DL-PDT）与传统光动力疗法（C-PDT）在预防有光化性损伤临床和组织学表现的患者中发生新的 NMSC 的安全性和疗效。
26 例患者面部或头皮有 NMSC 病史，同一部位有光化性角化病（AK），随机分为 DL-PDT 治疗侧和 C-PDT 治疗侧。在 12 个月的时间内，对个体进行临床评估，以了解新的 NMSC 的发生情况。
治疗侧之间新 AK 的总数和其发展的平均时间没有显著差异。C-PDT 组的局部不良反应更严重，与 C-PDT 相比，患者更倾向于 DL-PDT。
目前的研究结果表明，DL-PDT 与 C-PDT 预防表现出光化性损伤的患者中形成新的 NMSC 的潜力相当。
