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Unilateral Basal Cell Carcinomas: An Unusual Entity Treated with Photodynamic Therapy

  • Joshua E. LaneEmail author
  • Jennifer H. Allen
  • Tanda N. Lane
  • Jack L. LesherJr
Article

Abstract

Background

Unilateral localized basal cell carcinomas are an uncommon finding that presents both a diagnostic and therapeutic challenge. Exclusion of unilateral nevoid basal cell carcinoma syndrome is indicated. There are few reports in the literature regarding this entity and even less regarding therapeutic strategies.

Objective

We present a patient with unilateral localized basal cell carcinomas who was successfully treated with photodynamic therapy.

Methods

Photodynamic therapy was started using Levulan® Kerastick® as previously described. The topical solution was applied to the patient’s back and illuminated the following day via the BLU-U Blue Light Illuminator.

Results

The patient tolerated the procedure well and without complications. The patient had an excellent therapeutic response with no clinically apparent basal cell carcinomas for 18 months.

Conclusions

We report a patient with unilateral basal cell carcinomas successfully treated with photodynamic therapy. This uncommon entity represents a diagnostic challenge in its inherent absence of the classic clinical and radiographic findings of nevoid basal cell carcinoma syndrome. Like nevoid basal cell carcinoma syndrome, unilateral basal cell carcinomas poses a therapeutic challenge with the sheer number of cutaneous tumors. The use of photodynamic therapy carries a proven therapeutic efficacy, a low rate of adverse events and excellent cosmesis.

Keywords

Photodynamic Therapy Basal Cell Carcinoma Nevoid Basal Cell Carcinoma Syndrome Topical Imiquimod Superficial Basal Cell Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Sommaire

Antécédents

Le carcinome basocellulaire métastatique unilatéral localisé est rare et constitue un défi tant au niveau du diagnostic que du traitement. L’exclusion de la naevomatose basocellulaire est indiquée. Peu de rapports publiés traitent de cette entité ou des stratégies thérapeutiques.

Objectifs

Nous présentons le cas d’un patient atteint de carcinomes basocellulaires unilatéraux localisés qui a bien réagi à la thérapie photodynamique (TPD).

Méthodes

La thérapie photodynamique a été entamée au moyen de Levulan® Kerastick®. La solution topique a été enduite sur le dos du patient et illuminée, le lendemain, par le BLU-U Blue Light Illuminator.

Résultats

Le patient a bien toléré la procédure et aucune complication ne s’en est suivie. Le patient a bien réagi au traitement et a été libre de carcinomes cellulaires apparents pendant 18 mois.

Conclusion

Nous rapportons le cas d’un patient présentant des carcinomes basocellulaires unilatéraux localisés qui ont été traités au moyen de la TPD. Le diagnostic de cette entité rare est difficile en raison de l’absence dans les tests cliniques et radiologiques du syndrome de la naevomatose basocellulaire. Tout comme la naevomatose basocellulaire, le carcinome basocellulaire unilatéral pose un défi au niveau de la thérapie vu le seul nombre de tumeurs cutanées. Le recours à la thérapie photodynamique s’est avéré efficace, avec un faible taux d’événements indésirables et un bon résultat cosmétique.

Notes

Acknowledgments

We would like to acknowledge Brian C. Brockway, M.S. of the Department of Medical Photography and Illustration at the Veteran’s Affairs Medical Center in Augusta, Georgia for illustrations.

References

  1. 1.
    Gorlin RJ. Nevoid basal cell carcinoma syndrome. Dermatol Clin 1995; 13:113–125PubMedGoogle Scholar
  2. 2.
    Kimonis VE, Goldstein AM, Pastakia B, et al. Clinical features in 105 persons with nevoid basal cell carcinoma syndrome. Am J Med Genet 1997; 69:299–308PubMedCrossRefGoogle Scholar
  3. 3.
    Bale AE, Yu K. The hedgehog pathway and basal cell carcinomas. Hum Mol Gen 2001; 10:757–762PubMedCrossRefGoogle Scholar
  4. 4.
    Gailani MR, Bale SJ, Leffell DJ, et al. Developmental defects in Gorlin syndrome related to a putative tumor suppressor gene on chromosome 9. Cell 1992; 69:111–117PubMedCrossRefGoogle Scholar
  5. 5.
    Strong L. Genetic and environmental interactions. Cancer 1977; 40:1861–1866PubMedCrossRefGoogle Scholar
  6. 6.
    Kopera D, Cerroni L, Fink-Puches R, et al. Different treatment modalities for the treatment of a patient with the nevoid basal cell carcinoma syndrome. J Am Acad Dermatol 1996; 34:937–939PubMedCrossRefGoogle Scholar
  7. 7.
    Krunic AL, Viehman GE, Madai S, Clark RE. Microscopically controlled surgical excision combined with ultrapulse CO2 vaporization in the management of a patient with the nevoid basal cell carcinoma syndrome. J Dermatol 1998; 25:10–12PubMedGoogle Scholar
  8. 8.
    Doctoroff A, Oberlender SA, Purcell SM. Full-face carbon dioxide laser resurfacing in the management of a patient with the nevoid basal cell carcinoma syndrome. Dermatol Surg 2003; 29:1236–1240PubMedCrossRefGoogle Scholar
  9. 9.
    Marmur ES, Schmults CD, Goldberg DJ. A review of laser and photodynamic therapy for the treatment of nonmelanoma skin cancer. Dermatol Surg 2004; 30:264–271PubMedCrossRefGoogle Scholar
  10. 10.
    Jeffes EW, McCullough JL, Weinstein GD, et al. Photodynamic therapy of actinic keratoses with topical aminolevulinic acid hydrochloride and fluorescent blue light. J Am Acad Dermatol 2001; 45:96–104PubMedCrossRefGoogle Scholar
  11. 11.
    Szeimes RM, Karrer S, Sauerwald A, et al. Photodynamic therapy with topical application of 5-aminolevulinic acid in the treatment of actinic keratoses: an initial clinical study. Dermatology 1996; 192:246–251Google Scholar
  12. 12.
    Jeffes EW, McCullough JL, Weinsten GD, et al. Photodynamic therapy of actinic keratosis with topical 5-aminolevulinic acid. A pilot dose-ranging study. Arch Dermatol 1997; 133:727–732PubMedCrossRefGoogle Scholar
  13. 13.
    Rifkin R, Reed B, Hetzel F, et al. Photodynamic therapy using SnET2 for basal cell nevus syndrome: A case report. Clin Therap 1997; 19:639–641CrossRefGoogle Scholar
  14. 14.
    Thissen MRTM, Neumann MHA, Schouten LJ. A systematic review of treatment modalities for primary basal cell carcinomas. Arch Dermatol 1999; 135:1177–1183PubMedCrossRefGoogle Scholar
  15. 15.
    CappugiP, Campoli P, Mavilia L, et al. Topical 5-aminolevulinic acid and photodynamic therapy in dermatology: a minireview. J Chemother 2001; 13:494–502Google Scholar
  16. 16.
    Morton CA, Whitehurst C, McColl JH, et al. Photodynamic therapy for large or multiple patches of Bowen disease and basal cell carcinoma. Arch Dermatol 2001; 137:319–324PubMedGoogle Scholar
  17. 17.
    Morton CA, Brown SB, Collins S, et al. Guidelines for topical photodynamic therapy: Report of a workshop of the British Photodermatology Group. Br J Dermatol 2002; 146:552–567PubMedCrossRefGoogle Scholar
  18. 18.
    Morton CA. Photodynamic therapy for nonmelanoma skin cancer—and more? Arch Dermatol 2004; 140:116–120PubMedCrossRefGoogle Scholar
  19. 19.
    Rhodes LE, de Rie M, Enstrom Y, et al. Photodynamic therapy using topical methyl aminolevulinate vs surgery for nodular basal cell carcinoma: results of a multicenter randomized prospective trial. Arch Dermatol 2004; 140:17–23PubMedCrossRefGoogle Scholar
  20. 20.
    Sharpe GR, Cox NH. Unilateral naevoid basal-cell carcinoma syndrome – an individually controlled study of fibroblast sensitivity to radiation. Clin Exp Dermatol 1990; 15:352–355PubMedCrossRefGoogle Scholar
  21. 21.
    Karrer S, Szeimies RM, Hohenleutner U, et al. Unilateral localized basaliomatosis: Treatment with topical photodynamic therapy after application of 5-aminolevulinc acid. Dermatology 1995; 190:218–222PubMedGoogle Scholar
  22. 22.
    Itkin A, Gilchrest BA. Delta-Aminolevulinic acid and blue light photodynamic therapy for treatment of multiple basal cell carcinomas in two patients with nevoid basal cell carcinoma syndrome. Dermatol Surg 2004; 30:1054–1061PubMedCrossRefGoogle Scholar
  23. 23.
    Dougherty TJ, Kaufman JE, Goldfarb A, et al. Photoradiation therapy for the treatment of malignant tumors. Cancer Res 1978; 38:2628–2635PubMedGoogle Scholar
  24. 24.
    Dougherty TJ, Marcus SL. Photodynamic therapy. Eur J Cancer 1992; 28A:1734–1742PubMedCrossRefGoogle Scholar
  25. 25.
    Kennedy JC, Pottier RH, Pross DC. Photodynamic therapy with endogenous protoporphyrin IX: Basic principles and present clinical experience. J Photochem Photobiol B 1990; 6:143–148PubMedCrossRefGoogle Scholar
  26. 26.
    Kennedy JC, Pottier RH. Endogenous protoporphyrin IX, a clinically useful photosensitizer for photodynamic therapy. J Photochem Photobiol B 1992; 14:275–292PubMedCrossRefGoogle Scholar
  27. 27.
    Svanberg K, Anderson T, Killander D, et al. Photodynamic therapy of non-melanoma malignant tumours of the skin using topical 5-aminolevulinic acid sensitization and laser irradiation. Br J Dermatol 1994; 130:743–751PubMedCrossRefGoogle Scholar
  28. 28.
    Wolf P, Kerl H. Photodynamic therapy with 5-aminolevulinic acid: A promising concept for the treatment of cutaneous tumors. Dermatology 1995; 190:183–185PubMedCrossRefGoogle Scholar
  29. 29.
    Henderson BW, Dougherty TJ. How does photodynamic therapy work? Photochem Photobiol 1992; 55:145–157PubMedGoogle Scholar
  30. 30.
    Peng Q, Warloe T, Berg K, et al. 5-ALA based photodynamic therapy. Clinical research and future challenges. Cancer 1997; 79:2282–2308PubMedCrossRefGoogle Scholar
  31. 31.
    Cairnduff F, Stringer MR, Hudson EJ, et al. Superficial photodynamic therapy with topical 5-aminolevulinic acid for superficial primary and secondary skin cancer. Br J Cancer 1994; 69:605–608PubMedGoogle Scholar
  32. 32.
    Haller JC, Cairnduff F, Slack G, et al. Routine double treatments of superficial basal cell carcinomas using aminolevulinic acid-based photodynamic therapy. Br J Dermatol 2000; 143:1270–1274PubMedCrossRefGoogle Scholar
  33. 33.
    Ormrod D, Jarvis B. Topical aminolevulinic acid HCL photodynamic therapy. Am J Clin Dermatol 2000; 1:133–139PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Joshua E. Lane
    • 1
    • 4
    Email author
  • Jennifer H. Allen
    • 2
  • Tanda N. Lane
    • 3
  • Jack L. LesherJr
    • 1
  1. 1.Section of Dermatology, Department of MedicineThe Medical College of GeorgiaAugustaUSA
  2. 2.Allen Dermatology & Skin Cancer CenterMaconUSA
  3. 3.Department of DermatologyEmory University School of MedicineAtlantaUSA
  4. 4.Joshua E. LaneMaconUSA

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