Photodynamic therapy with epidermal ablation using fractional carbon-dioxide laser in the treatment of Bowen's disease: A case series

Abstract

BACKGROUND: Bowen's disease is an intraepithelial tumor, also known as squamous cell carcinoma in situ. Among those alternative treatments, PDT usually produce better cosmetic outcomes compared with those of 5-fluorouracil and cryosurgery. METHODS: Before the applications of photosensitizer, epidermis of the lesions were totally ablated by fractional CO2 laser (eCO2(R), Lutronic, Korea) with the following parameters: tip size 120 mum, peak power 30 W, pulse energy 50 mJ, 200 spots/cm(2). After the ablation of epidermis, methyl aminolevulinate (MAL) (Metvix(R), Galderma, France) was applied with incubation time of 90 minutes followed by light exposure. 630 nm light from Aktilite CL 128(R) (Galderma, Switzerland) was utilized at a light dose of 37 J/cm(2). The clinical improvement of the lesion was evaluated either as a complete response (CR, complete absence of lesion), a partial response (PR, 25 approximately 99% reduction in lesion) or no response (NR, 0 approximately 24% reduction in lesion). RESULTS: The treatment result was excellent (87.5% of clinical CR). No scar formation after the treatment was noted in 7 patients who achieved clinical CR. CONCLUSIONS: Total ablation of epidermis before PDT can enhance the treatment efficacy of PDT without adverse events in the treatment of Bowen's disease.