Two-fold illumination in topical 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) for superficial basal cell carcinoma (sBCC): A retrospective case series and cohort study

Background: There is limited literature on efficacy using a 2-fold illumination scheme in aminolevulinic acid (ALA) photodynamic therapy for superficial basal cell carcinoma (sBCC). Objectives: We sought to determine the efficacy of ALA photodynamic therapy for sBCC using a 2-fold illumination scheme after a single ALA application. Treatment failure within 12 months posttreatment was assessed. Methods: In this retrospective case series and cohort study, electronic files from patients treated between January 2010 and August 2011 were reviewed. Follow-up data were gathered until March 2014. Results: A total of 323 sBCC were analyzed for recurrence. Cumulative probability of clinical recurrence-free survival was 88.8% (95% confidence interval [CI] 85.4-92.4), 81.8% (95% CI 77.3-86.3), and 77.1% (95% CI 71.0-83.6) at 12, 24, and 48 months, respectively. For histologically confirmed recurrences this was 90.2% (95% CI 86.9-93.5), 85.4% (95% CI 75.5-89.3), and 81.8% (95% CI 75.5-88.1), respectively. A worse recurrence-free survival for tumors in the head and neck area and tumors larger than 10 mm was observed. Limitations: The retrospective nature and the lack of a control group are limitations. Conclusions: ALA photodynamic therapy using a 2-fold illumination scheme might be a feasible treatment option with acceptable long-term results for small sBCC located outside the head and neck area.