Expanding Non-surgical Options for Superficial BCC With Red Light PDT

In a recent Dermatology Times Expert Perspectives custom video series, Todd Schlesinger, MD, a dermatologist, Mohs surgeon, and clinical trialist at Epiphany Dermatology in South Carolina, discussed emerging evidence for red light–activated aminolevulinic acid (ALA) photodynamic therapy (PDT) and its potential role in expanding treatment options for appropriately selected patients.

“Photodynamic therapy has always been exciting for the management of different things,” Schlesinger said, noting its long-standing use in actinic keratosis. Over the past decade, however, interest has shifted toward non-surgical management of early-stage nonmelanoma skin cancers, particularly superficial basal cell carcinoma (sBCC). According to Schlesinger, recent studies evaluating red light plus 10% ALA PDT suggest the modality may help establish a new benchmark for non-surgical care in this setting.

Discussing outcomes from a recent study conducted by his group and others, Schlesinger highlighted encouraging clearance rates. Clinical clearance approached 85%, while histologic clearance was approximately 76%, with combined clinical and histologic clearance around 65%.¹ These findings demonstrate the importance of evaluating outcomes through multiple lenses. “Some of these patients are going to clear histologically… other ones will look clear, but maybe they’re not clear histologically,” he explained, emphasizing that clinical appearance alone may not tell the full story.

While surgical excision remains the gold standard for sBCC, Schlesinger views PDT as a valuable alternative for select patients, particularly those seeking non-surgical approaches or wishing to minimize scarring. “It also offers the patient an option to get rid of a superficial basal cell carcinoma that wouldn’t really require a large scar,” he said.

Schlesinger also addressed why red light appears better suited than blue light for sBCC treatment. Red light’s longer wavelength allows for deeper penetration through the epidermis and into the dermis, aligning more closely with the tumor’s anatomic location. “We want to have a high concentration of target light at the base of the epidermis,” he said. “It’s nice to have a light wavelength that penetrates deep enough so that we’re really concentrating the peak of that where we need it.”

Taken together, Schlesinger believes the evolving data support thoughtful consideration of red light–based PDT as part of the range of treatment options for sBCC, offering clinicians another evidence-based, tissue-sparing option for patient care.

Reference

1. Schlesinger T, Chapman MS, Tu JH, et al. Red light photodynamic therapy with 10% aminolevulinic acid gel showed efficacy for treatment of superficial basal cell carcinoma in a randomized, vehicle controlled, double-blind, multicenter phase III study. J Am Acad Dermatol. 2025;93(6):1489-1498. doi:10.1016/j.jaad.2025.08.031