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biomedicines Article Photodynamic Therapy Activated by Intense Pulsed Light in the Treatment of Nonmelanoma Skin Cancer Domenico Piccolo 1,2,* and Dimitra Kostaki 2 1 2 Received: 5 November 2017; Accepted: 29 January 2018; Published: 7 February 2018 Abstract: Photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) has proven to be a highly effective conservative method for the treatment of actinic keratosis (AK), Bowen’s disease (BD), and superficial basal cell carcinoma (sBCC). PDT is traditionally performed in association with broad-spectrum continuous-wave light sources, such as red or blue light. Recently, intense pulsed light (IPL) devices have been investigated as an alternative light source for PDT in the treatment of nonmelanoma skin cancers (NMSC). We herein report our observational findings in a cohort of patients with a diagnosis of AK, sBCC, and BD that is treated with MAL-PDT using IPL, as well as we review published data on the use of IPL-PDT in NMSC. Keywords: photodynamic therapy; nonmelanoma skin cancer; MAL; intense pulsed light device 1. Introduction Nonmelanoma skin cancer (NMSC) is the most common malignancy among the Caucasian population [1]. Over the last decades, the worldwide incidence is estimated to rise by 3–10% [2], presenting an increasing demand on healthcare resources. Surgery is the traditional “gold-standard” treatment since it provides high rates of disease control with clear identification of tumour margins [3]. NMSC are slow-growing skin tumours that are characterized by low risk of metastatic potential and favourable life prognosis; therefore, conservative therapies should be considered based on lesion’s characteristics (location and size), as well as patient’s specific factors (age, comorbidity, medications, immunosuppression). Photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) has proven to be a highly effective conservative method for the treatment of actinic keratosis (AK), Bowen’s disease (BD), and superficial basal cell carcinoma (sBCC), with the benefit of excellent cosmetic results and the potential for field treatment [4]. Originally developed to be used with broad-spectrum continuous-wave light sources such as red or blue light for the treatment of superficial cutaneous malignancies, PDT has more recently been used in combination with other light sources, including light-emitting diodes (LEDs), lasers, and incoherent light sources, with all giving adequate complete remission rates [5]. Intense pulsed light (IPL) is a source of incoherent light that was developed in the early 1990s that targets several chromophores, such as melanin, vascular structures, and collagen, thus improving photoaged skin. The rationale for using the IPL as a light source for PDT is based on the absorption spectrum of the photosensitizer and IPL’s features. Protoporphyrin IX (PpIX) has absorption peaks at 505, 540, 580, and 630 nm. IPL is a source of incoherent light with emission spectrum ranging of 500–1200 nm. By using different cut-off filters in the handpiece, the delivered wavelengths can be varied, underlying IPL’s versatility. Thus, the adaptation to the absorption spectrum of PpIX allows for the use of IPL for PDT [6]. Italian Association Outpatient Dermatologists, 00177 Rome, Italy Skin Center, Dermo-Aesthetic Lasers Centers, 67051 Avezzano, Italy; kostakidimi@hotmail.com * Correspondence: info@skincenters.it; Tel.: +39-0863-21253 or +39-338-8494134; Fax: +39-0863-21253 Biomedicines 2018, 6, 18; doi:10.3390/biomedicines6010018 www.mdpi.com/journal/biomedicinesPDF Image | Photodynamic Therapy Pulsed Light Treatment of Nonmelanoma
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