Methylaminolevulinic acid-based photodynamic therapy: the patient's view

Topical photodynamic therapy (PDT) with methylaminolevulinate (MAL) for nonmelanomatous skin cancers (NMSC) has proven efficient and safe. Because pain and a phototoxic reaction (PTR) are frequent side effects, the ability to predict discomfort may improve the management of patient care. During a 3-month period, we enrolled 46 patients with a total of 120 precancerous actinic skin lesions or NMSCs. Patients were treated with MAL-PDT, and follow-up continued for 8 wk. PDT had no lasting side effects in 65% of the lesions, and nearly 90% healed. The most frequent adverse cosmetic effect was skin discoloration (26.7%). Scarring was observed more often on the nose (21%, 3 of 14 lesions). Women experienced erythema more often than men (24% vs. 6%). With approximately 80% of the lesions, the patient reported light or no PTR. The average patient-reported pain during irradiation was moderate (4.92 on a scale of 0 to 10). Pain was persistent in 45% of the cases, but it decreased rapidly thereafter (on average 1 d). Risk factors for a greater severity of pain were lesions on the scalp (average pain score: 6.62) and on the forehead (average: 7.00) and treatment over an extended area (average: 7.32). Treatment on the nose (average: 3.29) or on the thorax (average: 3.00) was less painful. The final level of satisfaction reported was good or very good by 90% of the patients. Based on our results, eligible patients can be individually identified and informed in advance about the likelihood of side effects, thereby improving their satisfaction.