Reflectance confocal microscopy allows in vivo real-time noninvasive assessment of the outcome of methyl aminolaevulinate photodynamic therapy of basal cell carcinoma.

Abstract

BACKGROUND:

Photodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is an approved noninvasive treatment option for basal cell carcinoma (BCC). In vivo reflectance confocal microscopy (RCM) is a noninvasive imaging technique that has proved useful for in vivo real-time cytomorphological analysis of BCC cells infiltrating the epidermis.

OBJECTIVES:

  To investigate the use of in vivo RCM to assess the persistence of BCC cells surviving MAL-PDT.

METHODS:

In vivo  RCM images of 20 biopsy-proven BCCs were taken before patients underwent a treatment cycle with MAL-PDT. Follow-up after 3months was performed using clinical examination, RCM and conventional dermoscopy. Treated areas also underwent a targeted 3-mm punch biopsy for standard haematoxylin and eosin histology stain to establish the clinical and instrumental correlation of the treatment outcome.

RESULTS:

  Three months after PDT, clinical examination established that two out of 20 BCCs were persistent; dermoscopy found three out of 20 residual BCCs, but RCM showed that one of these lesions was a false positive, and showed persistent BCC foci in five out of 20 lesions. Histological analysis of targeted biopsies confirmed these results.

CONCLUSIONS:

  RCM provided noninvasive, early detection of incipient recurrences of BCC after MAL-PDT. RCM findings steered targeted biopsies and surgical removal, or a new MAL-PDT, of these subclinical recurrences with minimal invasiveness.

• Authors: M Venturini, R Sala, S Gonzàlez, P G Calzavara-Pinton
• Journal: The British journal of dermatology (Br J Dermatol) Vol. 168 Issue 1 Pg. 99-105 (Jan 2013) ISSN: 1365-2133 [Electronic] England
• PMID: 23013443 (Publication Type: Journal Article)
• Copyright: © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

Chemical References

• Photosensitizing Agents
• methyl 5-aminolevulinate
• Aminolevulinic Acid

Topics

• Adult
• Aged
• Aged, 80 and over
• Aminolevulinic Acid (analogs & derivatives, therapeutic use)
• Carcinoma, Basal Cell (drug therapy, pathology)
• Dermoscopy (methods)
• Female
• Follow-Up Studies
• Humans
• Male
• Microscopy, Confocal (methods)
• Middle Aged
• Neoplasm Recurrence, Local (drug therapy, pathology)
• Photochemotherapy (methods)
• Photosensitizing Agents (therapeutic use)
• Sensitivity and Specificity
• Skin Neoplasms (drug therapy, pathology)
• Treatment Outcome