Topical Photodynamic Therapy Clinical Practice Guidelines (2019)

British Association of Dermatologists and British Photodermatology Group

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

May 06, 2019

Guidelines on topical photodynamic therapy (PDT) were released in April 2019 by the British Association of Dermatologists and the British Photodermatology Group.[1]

Basal Cell Carcinoma

Topical PDT should be offered as a treatment option for superficial basal cell carcinoma (BCC), in particular for skin sites that are healing poorly or are cosmetically sensitive, in cases with multiple lesions, and in lesions that cover a large area.

Topical PDT can be considered for thin (<2 mm) nodular BCC in situations in which other treatments are impractical or contraindicated.

Further cycles of PDT can be given for residual lesions when a good response was achieved with prior treatment.

Topical PDT should not be offered as a standard treatment for nodular BCC at high‐risk sites.

For enhanced penetration for BCC, use red light and not light of a shorter wavelength (eg, blue light, green light, daylight).

Squamous Cell Carcinoma in situ (Bowen Disease)

Topical PDT should be offered as a treatment option for squamous cell carcinoma (SCC) in situ, in particular for skin sites that are healing poorly or are cosmetically sensitive, in cases with multiple lesions, and in lesions that cover a large area.

Actinic Keratosis

Topical PDT should be offered as a treatment option for actinic keratosis, in particular for skin sites that are cosmetically sensitive, in cases with multiple lesions, and in lesions that cover a large area.

Further cycles of PDT can be given for residual lesions when a good response was achieved with prior treatment.

Daylight topical PDT can be considered for mild (slightly palpable lesions, more easily felt than seen; Olsen grade I) or moderate (moderately thick lesions, easily felt; Olsen grade II) lesions when pain is likely, in particular for confluent areas on the scalp or face.

Combination treatment with topical PDT and other modalities (eg, imiquimod, pretreatment with ablative fractional laser) can be considered, if appropriate, for people with thick actinic keratoses (very thick or obvious lesions; Olsen grade III).

Squamous Cell Carcinoma

Topical PDT can be considered as a treatment option in microinvasive SCC if surgery is contraindicated.

Topical PDT should not be offered for invasive SCC.

Skin Cancer Prophylaxis

Topical PDT can be considered for prophylaxis to reduce the development of new lesions in patients with actinic keratosis or nonmelanoma skin cancer, including individuals who have undergone organ transplantation.

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