Actinic keratoses

Non-melanoma skin cancer

and

Photodynamic therapy

Dr Lucy Ostlere

Actinic keratoses

18.6M new cases/year in USA, Australia

and Europe

< 1% SCC

Treatment of actinic keratoses

No treatment

Cryotherapy

Solaraze gel

5-fluorouracil (Efudix)

5% imiquimod (Aldara)

Actikerall

Picato

Actinic keratoses

Pre- efudix 1 week post-efudix

Picato

Non-melanoma skin cancer

(BCC and SCC)

9 out of 10 skin cancer (>85% BCC)

62,000 new cases / year in UK

Incidence increasing by 5% / year

40% chance of 2nd NMSC within 5 years

Squamous cell

carcinoma

Treatment of SCC

Excision

Radiotherapy

Nodular and superficial BCC

Treatment of nodular bccs

Excision

Curettage and hyfrecation x 3

Radiotherapy

Morphoeic BCC

Treatment of morphoeic BCC

Excision +/- Mohs’ micrographic

surgery

Radiotherapy

Superficial BCC

Bowen’s disease

Non-surgical treatment of

superficial BCCs and Bowens

Cryotherapy

5% Imiquimod

Photodynamic therapy

Not suitable for BCCs on face

and lower leg

BCCs 30 secs x 2

Bowen’s 15 secs

Risk of post-inflammatory

hypopigmentation

Cryotherapy for superficial BCCs and Bowen’s disease

Case- Superficial BCC

Treatment with Imiquimod

Post- treatment

Photodynamic therapy

Light

Photo-

sensitiser

O2 O2

O2

O2

O2

ROS

Methylaminolaevulinate (MAL)

Light

Protoporphyrin IX + ROS

Destruction of abnormal cells

Photodynamic therapy

For superficial BCCs, Bowen’s disease

and actinic keratoses (rarely)

Excellent cosmetic result

Response rate of around 90% for

superficial BCCs