Taking treatment decisions in non-melanoma skin cancer-The place for topical photodynamic therapy (PDT)

Background: Epithelial non-melanoma skin cancer (NMSC) like actinic keratosis (AK), Bowen's disease (BD) and basal cell carcinoma (BCC) represent the most common malignancies in the fair skinned population. Epidemiological data reveal high incidences, especially for actinic keratoses, which are basically non-invasive squamous cell carcinomas, but fortunately bear a low risk of mortality for a single lesion. Nevertheless these lesions should be generally treated if other factors such as the state of the patient indicate that this is appropriate. The appearance of new treatment modalities like immuno-modulating topical agents, topical diclofenac, and photodynamic therapy in addition to a long list of already established treatments (curettage, surgery, cryotherapy, topical 5-fluorouracil, and many others) have led to the fact that patients and treating physicians have a large spectrum of therapeutic options to choose from. The same - with some variations holds true for Bowen's disease and BCC. Methods: Aim of this article is to offer an overview over NMSCs and their treatment options with emphasis on photodynamic therapy (PDT) as classical indications for PDT, to provide resources for guidelines for the treatment of these diseases, and to position PDT in this context by helping selecting patients that would profit most from topical PDT. Results: Sufficient evidence is available to regard PDT as a standard treatment modality for NMSC. In addition to randomized controlled trials, long-term experience helps to find out the most appropriate treatment modality in a given patient. Conclusion: Physicians treating NMSC should have access to PDT and be trained and experienced in its use. (C) 2009 Elsevier B.V. All rights reserved.