PDT vs. Traditional Treatments for Non-Melanoma Skin Cancer: Which is Right for You?

Introduction

Skin cancer is a prevalent concern, with non-melanoma skin cancers (NMSCs) affecting a significant portion of the population. In fact, it’s estimated that it’s the most common form of cancer in the UK and more common than all the other cancers put together. These cancers may not be as widely discussed as melanoma, but their impact is substantial, making effective treatment crucial.

Non-melanoma skin cancer (NMSC) primarily comprises two main types: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Basal cell carcinoma (BCC) is the most frequently diagnosed, typically characterised by its slow growth and lower tendency to spread. Squamous cell carcinoma (SCC), while less common than BCC, can be more aggressive and has a higher risk of metastasis if left untreated.

The importance of timely and appropriate treatment for NMSC cannot be overstated. Early detection and intervention greatly improve the chances of successful outcomes and minimise potential complications. Fortunately, there are several treatment options available, each with its own set of advantages and disadvantages.

This article aims to provide a comprehensive comparison of Photodynamic Therapy (PDT) and traditional treatment methods for non-melanoma skin cancer. We will weigh the pros and cons of each approach, considering factors such as effectiveness, side effects, cosmetic outcomes, and suitability for individual patients, to help you make informed decisions about your care.

Understanding Non-Melanoma Skin Cancer

• Types of NMSC:
  • Basal Cell Carcinoma (BCC): Most common, slow-growing.
  • Squamous Cell Carcinoma (SCC): Can be more aggressive.
• Causes and Risk Factors: Sun exposure, UV radiation, genetics, etc.
• Symptoms and Diagnosis: Visual examination, dermoscopy, biopsy.

Photodynamic Therapy (PDT)

Photodynamic Therapy (PDT) is a treatment that uses a combination of a photosensitising agent and a specific wavelength of light to destroy cancerous cells.

• Explanation of PDT:
  • Photosensitising agents: These are substances that, when exposed to light, produce a form of oxygen that can kill cells. They are applied to the skin, either topically as a cream or ointment, or sometimes injected.
  • Light activation: Once the photosensitising agent has been absorbed by the targeted cells, the area is exposed to a specific wavelength of light. This light activates the agent.
  • Cellular damage: The activation of the photosensitising agent triggers a reaction that produces toxic oxygen species, leading to the destruction of the cancerous cells.
• Pros of PDT:
  • Cosmetic benefits: PDT often results in minimal scarring, making it a preferred option for treating lesions on the face and other cosmetically sensitive areas.
  • Targeted treatment: PDT can selectively target cancer cells while causing less damage to surrounding healthy tissue.
  • Suitable for multiple or large areas: It can be used to treat multiple lesions or large areas of skin affected by NMSC.
  • Less invasive: PDT is a non-surgical procedure, reducing the risks and recovery time associated with surgery.
• Cons of PDT:
  • Side effects: Common side effects include redness, swelling, and photosensitivity (increased sensitivity to light) in the treated area. Patients must avoid sunlight for a period after treatment.
  • Multiple sessions may be needed: Depending on the size and type of NMSC, several PDT sessions may be required to achieve complete clearance.
  • Limitations: PDT’s effectiveness is limited by the depth of tumour penetration, making it less suitable for thicker or more invasive skin cancers.
• Ideal Candidates:
  • Superficial BCC and SCC.
  • Patients where surgery is not preferred due to medical reasons, cosmetic concerns, or the presence of multiple lesions.

Traditional Treatment Options

There are several traditional treatment options available for non-melanoma skin cancer.

• Surgery (Excision):
  • Procedure: Surgical excision involves cutting out the cancerous tissue and a margin of healthy skin around it. The wound is then closed with stitches.
  • Pros: Surgery often boasts a high success rate, particularly for well-defined NMSCs.
  • Cons: Surgery can result in scarring, is an invasive procedure, and requires a period of recovery.
  • Suitability: Surgical excision is typically suited for well-defined tumours, high risk tumours and in areas where scarring is less of a concern.
• Cryotherapy (Freezing):
  • Procedure: Cryotherapy involves freezing the cancerous tissue using liquid nitrogen, which destroys the cells.
  • Pros: It is a relatively quick procedure and requires minimal equipment.
  • Cons: Cryotherapy can damage surrounding healthy tissue, may necessitate multiple treatment sessions, and can potentially lead to scarring and has a lower cure rate.
  • Suitability: Cryotherapy is generally used for small, superficial lesions.
• Topical Medications:
  • Types: Topical medications include creams such as imiquimod.
  • Procedure: These medications are applied directly to the skin cancer.
  • Pros: Topical treatments are non-invasive and can be administered by the patient at home.
  • Cons: Treatment duration can be lengthy, and skin reactions such as redness and irritation are common.
  • Suitability: Topical medications are typically prescribed for superficial BCCs.
• Radiation Therapy:
  • Procedure: Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells.
  • Pros: It can be effective for large tumours or those located in difficult-to-treat areas.
  • Cons: Radiation therapy can cause side effects such as skin changes and requires multiple visits to the hospital.
  • Suitability: It is often used for patients who are not suitable candidates for surgery or for tumours in sensitive areas.

Comparative Analysis

• Case scenarios:

  • Example 1: An elderly patient with multiple superficial BCCs on the face, where minimising scarring and avoiding invasive procedures is a priority, PDT might be preferred.
  • Example 2: A younger patient with a well-defined SCC on the leg, where complete removal is crucial and cosmetic outcome is less of a concern, surgery might be the best option.

Choosing the Right Treatment

Selecting the most appropriate treatment for non-melanoma skin cancer requires careful consideration of several factors.

• Factors influencing the decision:
  • Tumour size, type, and location.
  • Patient’s age and overall health.
  • Cosmetic concerns and the potential for scarring.
  • Patient preferences and lifestyle.
• Importance of consultation with a dermatologist or specialist: A thorough consultation with a dermatologist or skin cancer specialist is essential to discuss all available options, weigh the benefits and risks, and develop an individualised treatment plan.

Conclusion

Choosing between Photodynamic Therapy (PDT) and traditional treatments for non-melanoma skin cancer is a highly personal decision, influenced by factors such as cancer type, location, cosmetic concerns, and your overall health. PDT stands out for its minimal scarring and targeted approach, making it ideal for superficial lesions and cosmetically sensitive areas. Traditional treatments, like surgery or cryotherapy, remain highly effective for deeper or more aggressive cancers. Ultimately, the best outcomes are achieved when you work closely with a specialist who understands your unique needs and can guide you through your options.

Take the Next Step: Expert Skin Cancer Care Awaits

Ready to explore the safest and most effective treatment for your skin?
Don’t leave your health to chance- consult with experienced dermatologists who put your well-being first. The Skin Care Network in North London offers advanced diagnostics, personalised care, and the latest in skin cancer treatments, including PDT and traditional options.
Book your consultation today and let their expert team help you make the best decision for your skin and your future.
Visit the Skin Care Network to get started.