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For the thicker, lump-like basal cell carcinoma, light treatment clears about as many at three months as surgery does, but over five years three times as many come back. What it buys is a better-looking result, and that is the whole of the trade.
Photodynamic therapy was being used for nodular basal cell carcinoma without randomised evidence, so this trial was built to supply some. European university dermatology departments randomised 101 adults with previously untreated nodular basal cell carcinoma to methyl aminolevulinate photodynamic therapy, given twice a week apart with red light at 75 J per square centimetre, or to simple excision.
The short-term result flattered the light. Complete response at three months was 48 of 53 lesions (91 per cent) with photodynamic therapy against 51 of 52 (98 per cent), a difference of 4.8 percentage points (-3.4 to 13.0, p=0.25), and thirteen patients with an incomplete response were re-treated. Five years of follow-up settled it: recurrence occurred in 7 of 49 lesions (14 per cent, 95 per cent confidence interval 6 to 27) after photodynamic therapy against 2 of 52 (4 per cent, 1 to 13), p=0.09, and the estimated sustained complete response rate was 76 per cent (59 to 87) against 96 per cent (84 to 99), p=0.01.
What photodynamic therapy bought was appearance, and the difference is large: 27 of 31 patients (87 per cent, 70 to 96) had an excellent or good cosmetic outcome after light against 19 of 35 (54 per cent, 37 to 71) after surgery, p=0.007. That is the honest shape of every non-surgical option in this disease. It is not a cure rate argument, it is a scar argument, and the person whose tumour is on the tip of the nose is entitled to weigh it.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
101 randomised.
7 of 49 lesions; 95 per cent confidence interval 6 to 27 · 2 of 52 lesions; 95 per cent confidence interval 1 to 13
Source95 per cent confidence interval 59 to 87 · 95 per cent confidence interval 84 to 99
Source27 of 31 patients; 95 per cent confidence interval 70 to 96 · 19 of 35 patients; 95 per cent confidence interval 37 to 71
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Lesion recurrence at 5 yearsprimary | Methyl aminolevulinate photodynamic therapy | 49 | 14% | - | 0.09 | link |
| Excision surgery | 52 | 4% | ||||
| Sustained lesion complete response at 5 years | Methyl aminolevulinate photodynamic therapy | - | 76% | - | 0.01 | link |
| Excision surgery | - | 96% | ||||
| Excellent or good cosmetic outcome at 5 years | Methyl aminolevulinate photodynamic therapy | 31 | 87% | - | 0.007 | link |
| Excision surgery | 35 | 54% |
Shares Photodynamic therapy against imiquimod against fluorouracil for superficial basal cell carcinoma, Creams, light and cold for basal cell carcinoma, Basal cell carcinoma, Skin cancer (all types).
Shares Photodynamic therapy against cryotherapy for superficial basal cell carcinoma, Creams, light and cold for basal cell carcinoma, Basal cell carcinoma, Skin cancer (all types).
Shares Photodynamic therapy against imiquimod against fluorouracil for superficial basal cell carcinoma, Creams, light and cold for basal cell carcinoma, Basal cell carcinoma, Skin cancer (all types).
Shares Creams, light and cold for basal cell carcinoma, Basal cell carcinoma, Skin cancer (all types).
Shares Photodynamic therapy lasers and light sources, Basal cell carcinoma, Skin cancer (all types).
Shares Photodynamic therapy against imiquimod against fluorouracil for superficial basal cell carcinoma, Creams, light and cold for basal cell carcinoma, Basal cell carcinoma, Skin cancer (all types).
Shares Aminolevulinic acid (topical, for photodynamic therapy), Photodynamic therapy lasers and light sources.
Shares Aminolevulinic acid (topical, for photodynamic therapy), Basal cell carcinoma.