Mosterd K, Thissen MRTM, Nelemans P et al.
University Hospital Maastricht, Maastricht, The Netherlands.
Br J Dermatol 2008;159:864–70.
Editor’s note: Surgical excision is the gold standard in the treatment of basal cell carcinoma (BCC). However, photodynamic therapy (PDT) is an effective treatment option for superficial BCC that provides a good cosmetic outcome and is sometimes preferable to surgery. Recent guidelines formulated upon review of the literature have suggested that PDT is also an effective and reliable treatment for thin nodular BCC. However, these guidelines give no definition of “thin”, nor do they address the methods by which thickness should be measured. The authors of the present article conducted a prospective, randomized, controlled study involving 149 patients with a total of 173 primary histologically-proven nodular BCCs. Eighty-five patients were allocated to receive PDT and 88 were assigned to undergo surgical excision. The tumors in the PDT group were subject to partial debulking 3 weeks prior to treatment. PDT consisted of 5-aminolaevulinic acid (ALA) applied to the nodular BCC, followed by illumination with a broadband metal-halogen light source 4 h later. The illumination was repeated on the same day. In those who received surgical excision, a 3-mm tumor-free margin was maintained.