Abstract
Objective:
To evaluate the feasibility and efficacy of a pulsed dye laser (PDL) during a 5-week course of 5% topical imiquimod application in a patient with a nodular basal cell carcinoma (BCC) and to review the literature for data on PDL treatment of BCC.
Methods:
A 74-year-old patient with a 7-mm biopsy-proven BCC on his nose was treated with topical daily imiquimod for 2 weeks. Subsequently a laser session was performed with a flash lamp-pumped dye laser at 595 nm (Dermobeam 2000; Deka M.E.L.A., Florence, Italy) employing one pass with the following parameters: fluence 15 J/cm2, 3-ms pulses, spot diameter 5 mm with 10% overlap. PubMed was searched using the term conjunctions [“basal cell carcinoma” AND “pulsed dye laser”], [“basal cell carcinoma” AND “laser therapy”] and [“skin cancer” AND “pulsed dye laser”]. Frequency counts and percentages were employed to summarize identified BCC cases treated with PDL along different studies and Fisher’s exact test was used for the comparison of frequency distributions.
Results:
Topical imiquimod was continued for a further 3 weeks after the PDL session with a minimal increase in irritation. The tumor cleared and there has been no recurrence for 12 months. The literature search revealed a total of 7 small studies that included 120 tumors, the majority treated with a 595-nm device (104/120). Overall 81/120 (67.5%) treated tumors have been assessed as complete responders. No differences were recorded in relapse rates in association with the localization of the tumor, the histology (superficial vs. non-superficial), the wavelength of the device employed (595 vs. 585 nm), or the application of dynamic cooling. From the treatment parameters, only the use of multiple vs. single PDL sessions affected the outcome favorably (p=0.0432; Fisher’s exact test). From the BCC parameters, tumor size was a negative predictor of response.
Conclusion:
The combination of PDL with imiquimod could be a promising approach for the treatment of BCC and should be further evaluated in future studies.
Zusammenfassung
Ziel:
Evaluierung der Anwendbarkeit und Wirksamkeit eines gepulsten Farbstofflasers (pulsed dye laser, PDL) zur Behandlung eines Patienten mit nodulärem Basaliom innerhalb eines 5-wöchigen Behandlungszyklus mit Imiquimod 5% und Auswertung der Literatur zum Thema PDL-Behandlung von Basalzellkarzinomen (basal cell carcinoma, BCC).
Methoden:
Ein 74-jähriger Patient mit einem 7-mm großen, durch Biopsie nachgewiesenen BCC auf der Nase wurde täglich über einen Zeitraum von 2 Wochen topisch mit Imiquimod behandelt. Anschließend wurde eine Laserbehandlung mit einem 595 nm-PDL (Dermobeam 2000; Deka MELA, Florenz, Italien) unter Verwendung folgender Parameter durchgeführt: Energiedichte 15 J/cm2, 3 ms-Pulse, Spotdurchmesser 5 mm mit 10% Überlappung. Eine PubMed-Literaturrecherche zu folgenden Suchbegriffkombinationen wurde durchgeführt: [“Basaliom” UND“gepulster Farbstofflaser”], [“Basaliom” UND “Lasertherapie”] und [“Hautkrebs” UND “gepulster Farbstofflaser”]. Häufigkeiten und Prozentsätze wurden herangezogen, um entlang der verschiedenen Studien relevante Behandlungsfälle (mittels PDL behandelte BCC) zu identifizieren. Der Fisher-Test wurde für den Vergleich der Häufigkeitsverteilungen eingesetzt.
Ergebnisse:
Die Behandlung mit Imiquimod wurde für weitere 3 Wochen nach der PDL-Sitzung fortgesetzt, was mit minimalen Hautirritationen verbunden war. Der Tumor ging komplett zurück; ein Rezidiv trat innerhalb der ersten 12 Monate nach der Therapie nicht auf. Die Literaturrecherche ergab insgesamt 7 kleine Studien mit 120 Tumoren; die meisten wurden mit einem 595 nm-Laser (104/120) behandelt. Insgesamt bildeten sich 67,5% (81/120) der behandelten Tumoren komplett zurück. Es wurden keine Unterschiede in den Rückfallraten in Verbindung mit der Lokalisation des Tumors, der Histologie (oberflächlich vs. nicht-oberflächlich), der Wellenlänge des verwendeten Lasers (595 vs. 585 nm) oder der Anwendung einer dynamischen Kühlung während der Laserbehandlung festgestellt. Von den Behandlungsparametern beeinflusste lediglich eine höhere Zahl von Laser-Sitzungen im Vergleich zu Einzelsitzungen das Ergebnis positiv (p=0,043; Fisher-Test). Von den BCC-Parametern, stellte die Tumorgröße einen negativen Prädiktor für den Behandlungserfolg dar.
Fazit:
Die Kombination von PDL mit Imiquimod könnte ein vielversprechender Ansatz für die Behandlung von BCC sein, der in zukünftigen Studien weiter evaluiert werden sollte.
Acknowledgments
This study was partially supported by the University of Ioannina, Special Research Committee Account No. 81050. The authors are indebted to Prof. Dr. Max Hundeiker for valuable suggestions during the preparation of this manuscript.
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