Field-Directed PDT May Improve Long-Term Management of Actinic Damage and Superficial BCC

Photodynamic therapy (PDT) continues to be a valuable option in the management of actinic keratoses (AKs), photoaging, and select nonmelanoma skin cancers, according to Neal Bhatia, MD, director of clinical dermatology at Therapeutics Clinical Research in San Diego, California.

During a recent Dermatology Times Expert Perspectives video series discussion, Bhatia emphasized that PDT offers clinicians an opportunity to address broader areas of field cancerization rather than targeting only visible lesions.

“With PDT, we talk about scarring, pigmentation change, photoaging, and again, for me, it’s talking about the field of treatment, not just the individual lesions,” Bhatia said. “I incorporate both of those.”

Cosmetic Considerations and Patient Preference

Bhatia noted that cosmetic outcomes remain an important consideration when counseling patients, particularly compared with surgical intervention. Although surgery remains essential for definitive tumor management in many cases, concerns surrounding scarring may influence patient decision-making.

“If surgery is the issue, then we’re cutting out what we see, we’re cutting out the margin, and then we’re dealing with the surgical scar,” he said. “Many patients are afraid of them.”

According to Bhatia, discussions surrounding PDT should include both immediate and long-term benefits, including improvements in photodamage and reductions in future AK burden.

“Talking to patients about the potential benefits to the treatment area and down the road what they could be experiencing in terms of photoaging and reduction of AKs all comes into play,” he said.

He added that PDT should remain part of clinicians’ treatment algorithms whenever available.

“If PDT is an option in the office, it has to be in the algorithm mix,” Bhatia said. “Patient preference for scarring and cosmesis is important, but the definitive resolution of the tumor or cancer in front of them has to be the priority.”

Emerging Data With Next-Generation Light Sources

Bhatia also highlighted ongoing research evaluating PDT with newer red- and blue-light technologies for superficial basal cell carcinoma.

“There are some ongoing studies with red light with superficial basal cell, and there are some others with blue light that have been proven, especially with the next-generation lights that are in front of us,” he said.

He suggested these advances may further expand opportunities for PDT integration alongside or, in some cases, instead of surgery for carefully selected patients and treatment sites.

Encouraging Greater PDT Adoption

For clinicians hesitant to incorporate PDT into practice, Bhatia encouraged greater familiarity with established treatment protocols and educational resources.

“The first thing I would say is try it,” he said. “I would not be afraid of what photodynamic therapy can offer.”

Bhatia also stressed that structured pretreatment and posttreatment protocols can help optimize patient experience and outcomes.

“There are some good algorithms for pretreatment, for the day of treatment, for the day after treatment, as well as maintaining the gains and keeping symptoms low,” he said. “Follow some of those algorithms.”

View the full series here.