Photodynamic Therapy

Photodynamic Therapy

Photodynamic Therapy (‘PDT”) is a minimally-invasive treatment for certain types of superficial skin cancers and premalignant lesions. By combining topical drugs called photosensitising agents (‘PSA”), and specific wavelengths of light, PDT destroys abnormal cells without the incisions and scarring associated with surgical treatment of skin cancers. PDT may be recommended to treat actinic keratosis (precancerous changes in the skin due to sun damage) and superficial non-melanoma skin cancers. Two treatments may be necessary to to treat superficial non-melanoma skin cancers.

What happens during PDT

PDT treatment consists of the following steps:

1. 1. Lesion preparation - before the PSA is applied, the area will be prepared by removing scales and crusts from the skin with a small curette to roughen the skin surface. This preparation helps the PSA to be absorbed by the abnormal cells that cause lesions. The area will then be cleansed with a saline solution to ensure that the skin surface is clean and free from products that may stop the PSA from being absorbed properly.
   2. Application of the PSA - Metvix cream or ALA-5 (20%-aminolevulanic acid) is applied to the skin of the area being treated. An occlusive dressing or face covering will be used to keep sunlight off the area while the PSA is being absorbed. You are then free to leave the practice for a prescribed amount of time. You must avoid the sun and must not remove the dressing. Please take some pain relief 30 minutes prior to the time you are due to return to the If you do not have any, some paracetamol will be provided to you.
   3. Exposure to PDT Lamp- Please ensure you return to the practice in a timely manner so the PSA can be removed at the right time. Once you return to the practice, the PSA will be removed with saline solution. Once the area is cleaned, your nurse will set up the PDT lamp. You will be provided with protective eyewear as the PDT lamp is an intense bright red You will be exposed to the PDT lamp for 20-40 minutes, depending on treatment area. The number of treatments required varies from person to person. Dr Becker will discuss this with and you may be asked to return for subsequent treatments.
   4. After your treatment - Localised discomfort around the treatment area is common immediately after treatment and you may feel a burning sensation like you feel when you have a sunburn. You will be provided with a CeraVe after care kit, please use this kit which helps keep skin moisturised and can reduce crusting. Ice packs or cold, wet towels can be useful to manage discomfort at home. Other common side effects are common to a sunburn, you may experience blisters, swelling, bruising, peeling or weeping skin. It is imperative that you remain out of the sunlight for the initial 48 hours post treatment. Further exposure to sunlight will reactivate the PSA and continue the treatment. The treated area will be sun sensitive for the first few weeks after treatment, please be careful with ongoing sun exposure and use a high quality, zinc based sunscreen to protect the area.

How do I care for my skin after PDT

You will be provided with an aftercare information sheet on the day of your appointment and an after care kit with cleanser and moisturiser. It is also recommended that you prepare for your appointment by having a gel pack chilling in the freezer ready for use.

Is PDT painful?

Some patients can find PDT painful and the use of cold air, paracetamol and occasionally, local anaesthetic is used to manage the pain. You will be asked throughout the treatment about your level of pain and changes to the treatment are made according to your response. You may experience pain in the days following treatment, ice packs/cool wash cloths and pain relief can be used to manage this at home.

Benefits of PDT

Patients have many options when it comes to treating superficial non-melanoma skin cancers and photo damage. PDT offers the following advantages:

1. 1. Safe and effective
   2. Minimally invasive
   3. Little or no scaring
   4. Reduced downtime
   5. Good cure rate for Basal Cell Carcinomas and Squamous Cell Carcinomas
   6. Can treat large areas at once
   7. Can be performed in any season

How to prepare for PDT?

Make sure that you have some gel packs in the freezer at home and that your home is arranged so that you can spend a few days at home resting. Have some pain relief ready at home and bring some with you to your appointment as well, normal paracetamol or your regular pain relief is fine.  Please make sure that you attend your appointment with clean skin, free of make up, moisturisers or topical creams.

If you have any questions before or after your treatment, please contact this practice and ask to speak with one of our nurses.

Are there any complications from PDT? 

In addition to the mild side effects mentioned above, PDT can also lead to skin crusting or prolonged irritation and peeling. More serious reactions can occur in people treated for a large number of pre-cancerous lesions because their skin is absorbing more of the drug. Complications can also arise in people who fail to protect their skin from the sun after treatment. Fortunately, these complications usually go away within a week or two and don’t interfere with the treatment results. With a severe reaction there may be longterm or possible permanent colour changes (darker or lighter) of the skin. Redness of the skin may also last for several weeks.

Review appointment after PDT treatment 

A follow up appointment will be made for you with Dr Becker 8 - 12 weeks after your PDT treatment. If  you are experiencing excessive redness, burning or pustules please contact us and speak to one of our nurses. You can also come in and show us if you would prefer. 

Does Medicare cover PDT? 

Please note that this procedure is paid by the patient in full as Medicare does not cover PDT treatment.