Photodynamic therapy with 5-aminolevulinic acid for basal squamous cell carcinoma
https://doi.org/10.24931/2413-9432-2025-14-3-43-51
Abstract
The aim of the study was to collect and analyze published data from clinical trials on the efficacy of photodynamic therapy (PDT) using 5-ALA-based drugs and its esters in patients with basal cell carcinoma (BCC). The review was conducted using the PubMed and ClinicalTrials.gov databases for the period from 1995 to 2025. Large prospective and retrospective studies with more than 20 patients were included in the analysis. The efficacy of PDT was examined and compared with traditional treatment methods. The analysis demonstrated significant efficacy of PDT in the treatment of BCC. The complete regression rate ranged from 84% to 99% after 3 months of therapy, from 62% to 96% after 12 months, and from 70% to 91% after 5 years. A significantly better cosmetic outcome was recorded compared with surgical methods. Studies have confirmed that PDT has a high safety profile, with severe side effects rare. The most common adverse effects include mild skin irritation, redness, and mild discomfort, which resolve on their own.
About the Authors
E. V. Filonenko
P.A. Herzen Moscow Oncology Research Center – branch of FSBI NMRRC of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Moscow
V. I. Ivanova-Radkevich
Peoples’ Friendship University of Russia (RUDN University)
Russian Federation
Russian Federation
Moscow
References
1. Basset-Seguin N., Herms F. Update on the management of basal cell carcinoma. Acta dermato-venereologica, 2020, Vol. 100 (11), рр. 5750.
2. Samulenko A., Mordovsky A., Polyakov A. Modern Treatment Strategy for Basal Cell Carcinoma of the Head and Neck. Vrach, 2017, No. 12, рр. 5-8.
3. Edited by A.D. Kaprin, V.V. Starinsky, A.O. Shakhzadova. The State of Cancer Care in Russia in 2024. − Moscow: P.A. Herzen Moscow Research Institute of Oncology, a branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, 2025, р. 275.
4. Peris K. et al. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma – update 2023. European Journal of Cancer, 2023, Vol. 192, рр. 113254.
5. Krynitz B. et al. Risk of basal cell carcinoma in Swedish organ transplant recipients: a population-based study. British Journal of Dermatology, 2016, Vol. 174(1), рр. 95-103.
6. Clinical Guidelines – Basal Cell Skin Cancer – 2020-2021-2022 (20.01.2023) – Approved by the Ministry of Health of the Russian Federation.
7. Reiter O. et al. The diagnostic accuracy of dermoscopy for basal cell carcinoma: A systematic review and meta-analysis. Journal of the American Academy of Dermatology, 2019, Vol. 80(5), рр. 1380-1388.
8. Filonenko E.V., Grigoriev N.I. Photodynamic Therapy for a Patient with Basal Cell Carcinoma of the Lower Eyelid Skin (Clinical Case). Biomedical Photonics, 2023, Vol. 12(4), рp. 30-32. doi: 10.24931/2413–9432–2023–12-4-30–32.
9. Peris K. et al. Diagnosis and treatment of basal cell carcinoma: European consensus–based interdisciplinary guidelines. European Journal of cancer, 2019, Vol. 118, рр. 10-34.
10. McCusker M. et al. Metastatic basal cell carcinoma: prognosis dependent on anatomic site and spread of disease. European journal of cancer, 2014, Vol. 50(4), рр. 774-783.
11. Morton C. et al. European Dermatology Forum Guidelines on topical photodynamic therap. European Journal of Dermatology, 2015, Vol. 25(4), рр. 296-311.
12. Schulten R. et al. Comparison of the uptake of 5-aminolevulinic acid and its methyl ester in keratinocytes and skin. Naunyn-Schmiedeberg's archives of pharmacology, 2012, Vol. 385(10), рр. 969-979.
13. Van Loo E. et al. Surgical excision versus Mohs’ micrographic surgery for basal cell carcinoma of the face: a randomised clinical trial with 10 year follow-up. European Journal of Cancer, 2014, Vol. 50(17), рр. 3011-3020.
14. Zeitouni N. C. et al. 5-aminolevulinic acid photodynamic therapy for the treatment of basal and squamous cell carcinoma: A systematic review. Photodiagnosis and Photodynamic Therapy, 2025, рр. 104649.
15. Williams H. C. et al. Surgery versus 5% imiquimod for nodular and superficial basal cell carcinoma: 5-year results of the SINS randomized controlled trial. Journal of Investigative Dermatology, 2017, Vol. 137(3), рр. 614-619.
16. Wang J. Y. et al. Photodynamic Therapy: Clinical Applications in Dermatology. Journal of the American Academy of Dermatology, 2025.
17. Calzavara-Pinton P.G. et al. Methylaminolaevulinate-based photodynamic therapy of Bowen’s disease and squamous cell carcinoma. British Journal of Dermatology, 2008, Vol. 159(1), рр. 137-144.
18. Keyal U. et al. Present and future perspectives of photodynamic therapy for cutaneous squamous cell carcinoma. Journal of the American Academy of Dermatology, 2019, Vol. 80(3), рр. 765-773.
19. Filonenko E.V., Ivanova-Radkevich V.I. Photodynamic therapy of cutaneous squamous cell carcinoma. Biomedical Photonics, 2024, Vol. 13(4), рр. 33-39. doi: 10.24931/2413-9432-2024-13-4-33-39
20. Filonenko E.V., Ivanova-Radkevich V.I. Photodynamic therapy of Bowen’s disease. Biomedical Photonics, 2023, Vol. 12(4), рр. 22-29. doi: 10.24931/2413-9432-2023-12-4-22-29
21. Kessels J.P.H.M. et al. Treatment of superficial basal cell carcinoma by topical photodynamic therapy with fractionated 5-aminolaevulinic acid 20% vs. two-stage topical methyl aminolaevulinate: results of a randomized controlled trial. British Journal of Dermatology, 2018, Vol. 178(5), рр. 1056-1063.
22. Van Delft L.C.J. et al. Long-term efficacy of photodynamic therapy with fractionated 5-aminolevulinic acid 20% versus conventional two-stage topical methyl aminolevulinate for superficial basal-cell carcinoma. Dermatology, 2022, Vol. 238(6), рр. 1044-1049.
23. Salmivuori M. et al. Hexyl aminolevulinate, 5-aminolevulinic acid nanoemulsion and methyl aminolevulinate in photodynamic therapy of non-aggressive basal cell carcinomas: A non-sponsored, randomized, prospective and double-blinded trial. Journal of the European Academy of Dermatology and Venereology, 2020, Vol. 34(12), рр. 2781-2788
24. Arits A.H.M.M. et al. Photodynamic therapy versus topical imiquimod versus topical fluorouracil for treatment of superficial basal-cell carcinoma: a single blind, non-inferiority, randomised controlled trial. The lancet oncology, 2013, Vol. 14(7), рр. 647-654.
25. Roozeboom M. H. et al. Three-year follow-up results of photodynamic therapy vs. imiquimod vs. fluorouracil for treatment of superficial basal cell carcinoma: a single-blind, noninferiority, randomized controlled trial. Journal of Investigative Dermatology, 2016, Vol. 136(8), рр. 1568-1574.
26. Jansen M.H.E. et al. Five-year results of a randomized controlled trial comparing effectiveness of photodynamic therapy, topical imiquimod, and topical 5-fluorouracil in patients with superficial basal cell carcinoma. Journal of Investigative Dermatology, 2018, – Vol. 138(3), рр.527-533.
27. Morton C.A. et al. A randomized, multinational, noninferiority, phase III trial to evaluate the safety and efficacy of BF-200 aminolaevulinic acid gel vs. methyl aminolaevulinate cream in the treatment of nonaggressive basal cell carcinoma with photodynamic therapy. British Journal of Dermatology, 2018, Vol. 179(2), рр. 309-319.
28. Tserkovsky D.A., et al. Photodynamic therapy of basal cell skin cancer with the photosensitizer Photolon. Biomedical Photonics, 2017, Vol. 6(1), рр. 12-19.
29. Mosterd K. et al. Fractionated 5-aminolaevulinic acid–photodynamic therapy vs. surgical excision in the treatment of nodular basal cell carcinoma: results of a randomized controlled trial. British Journal of Dermatology, 2008, Vol. 159(4), рр. 864-870.
30. Roozeboom M.H. et al. Fractionated 5-aminolevulinic acid photodynamic therapy after partial debulking versus surgical excision for nodular basal cell carcinoma: a randomized controlled trial with at least 5-year follow-up. Journal of the American Academy of Dermatology, 2013, Vol. 69(2). – Р. 280-287
31. Kapinus V.N. et al. Possibilities of photodynamic therapy in the treatment of basal cell skin cancer relapses. Oncology. Journal named after PA Herzen, 2013, Vol. 1(4), рp. 40-44.
32. de Haas E.R.M. et al. Fractionated illumination significantly improves the response of superficial basal cell carcinoma to aminolevulinic acid photodynamic therapy. Journal of investigative dermatology, 2006, Vol. 126(12), рр. 2679-2686
33. De Vijlder H.C. et al. Light fractionation significantly improves the response of superficial basal cell carcinoma to aminolaevulinic acid photodynamic therapy: five-year follow-up of a randomized, prospective trial. Acta dermato-venereologica, 2012, Vol. 92(6), рр. 641-647.
34. Foley P. et al. Photodynamic therapy with methyl aminolevulinate for primary nodular basal cell carcinoma: results of two randomized studies. International journal of dermatology, 2009, Vol. 48(11), рр. 1236-1245.
35. Basset-Seguin N. et al. Topical methyl aminolaevulinate photodynamic therapy versus cryotherapy for superficial basal cell carcinoma: a 5 year randomized trial. European Journal of dermatology, 2008, Vol. 18(5), рр. 547-553.
36. Šmucler R., Vlk M. Combination of Er: YAG laser and photodynamic therapy in the treatment of nodular basal cell carcinoma. Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery, 2008, Vol. 40(2), рр. 153-158.
37. Rhodes L. E. et al. Photodynamic therapy using topical methyl aminolevulinate vs surgeryfor nodular basal cell carcinoma: results of a multicenter randomized prospective trial. Archives of dermatology, 2004, Vol. 140(1), рр. 17-23.
38. Rhodes L. E. et al. Five-year follow-up of a randomized, prospective trial of topical methyl aminolevulinate photodynamic therapy vs surgery for nodular basal cell carcinoma. Archives of dermatology, 2007, Vol. 143(9), рр. 1131-1136
39. Berroeta L. et al. A randomized study of minimal curettage followed by topical photodynamic therapy compared with surgical excision for low-risk nodular basal cell carcinoma. British Journal of Dermatology, 2007, Vol. 157(2), рр. 401-403.
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41.
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For citations:
Filonenko E.V., Ivanova-Radkevich V.I. Photodynamic therapy with 5-aminolevulinic acid for basal squamous cell carcinoma. Biomedical Photonics. 2025;14(3):43-51. https://doi.org/10.24931/2413-9432-2025-14-3-43-51
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