Methyl aminolevulinate (Metvix) photodynamic therapy - practical pearls

Topical photodynamic therapy (PDT) is an effective treatment for certain non-melanoma skin cancers (NMSCs), including superficial and nodular basal cell carcinomas (sBCC and nBCC), actinic keratosis (AK) and Bowen's disease. Methyl aminolevulinate (MAL, Metvix) is licensed in Europe for use in PDT for sBCC, nBCC and thin or non-hyperkeratotic and non-pigmented AK on the face and scalp, where other therapies are unsuitable. Optimal PDT response can be achieved through appropriate patient selection and lesion preparation. Evidence of efficacy is reviewed from guidelines and clinical experience. Red light from an LED source offers a relatively efficient method of activating the photodynamic reaction. The most common side effect of PDT is pain, burning or stinging discomfort at the site of treatment, although most patients do not request pain relief. The incidental observation of surface fluorescence three hours after photosensitizer application can be utilized for tumour detection as well as delineation. Topical PDT using Metvix MAL offers a practical non-invasive therapy option with the potential for high efficacy and good cosmesis.