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Background: Photodynamic therapy (PDT) has been strongly recommended as an excellent alternative treatment for Bowen disease (BD). However, reported data on 5-aminolaevulinic acid-mediated PDT (ALA-PDT) with red-light irradiation are limited and the long-term effectiveness remains to be determined, especially in dark-skinned populations., Objectives: We aimed to review routine clinical practice in the field of BD treatment with ALA-PDT over an extended study period (2011-2021), calculate the overall clearance rate, and explore and evaluate factors that might affect the effectiveness of therapy in a real-world setting., Methods: The medical records of patients with BD who received ALA-PDT with red-light irradiation between February 2011 and June 2021 were reviewed and summarized. Univariate and multivariate analyses of clinically relevant variables that may affect treatment outcomes were conducted to identify risk predictors., Results: The overall clearance rate of 122 BD lesions was 89.3% with a median follow-up time of 36 months. The correlation between the effectiveness and fluorescence intensity of pre-PDT or PDT sessions was statistically significant after eliminating the interference of confounding factors. All recurrences occurred in the first 2 years following ALA-PDT., Conclusions: ALA-PDT is an effective treatment for BD in patients with darker-coloured skin. Well-executed operations and effective pretreatment are the determinants of effectiveness. Fluorescence intensity of pre-PDT appeared to be a significant predictor of final effectiveness. In addition, 2 years of follow-up is necessary following ALA-PDT., Competing Interests: Conflicts of interest The authors declare they have no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background/objectives: Actinic keratoses (AK) are premalignant skin lesions caused by chronic sun exposure, topically managed by 5-fluorouracil (5-FU), diclofenac 3% gel, and imiquimod. Despite their effectiveness, long treatment duration and severe adverse local skin reactions have limited patient concordance. Calcipotriol has recently been used as a combination agent for existing topical AK treatments. A systematic review was performed to determine the clinical efficacy of 5-FU and calcipotriol for the treatment of AK, Bowen's disease, and squamous cell carcinoma (SCC)., Methods: A systematic literature search was conducted on Medline, Embase, and Cochrane Library. Among the 84 records screened, 12 were retrieved for full-text review and 8 were included in the final analysis., Results: Among the 8 studies, there were 214 control patients and 288 patients who received the intervention. The combination 5% 5-FU with calcipotriol resulted in a significant reduction in the number of AKs on the face, scalp, right upper extremity, and left upper extremity for all sites at 8 weeks ( P < .0001). No significant difference in SCC incidence was observed at 1 or 2 years, but there was a significant reduction observed at 3 years for SCC on face and scalp. No study assessed the combination for Bowen's disease., Conclusions: Combination 5% 5-FU with calcipotriol is an effective treatment for Aks; however, future trials may consider longer treatment and follow-up periods for the treatment and prevention of AK, SCC in situ, and SCC., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Photodynamic therapy (PDT) is a non-invasive, effective treatment for superficial skin conditions, offering superior cosmetic outcomes compared with traditional therapies. Bowen's disease (BD) of the nipple-areola complex (NAC) is rare and thus, lacks a standardized treatment approach. This report details the case of a 48-year-old woman who was successfully treated for BD of the NAC using PDT. Over a follow-up period of 30 months, there was no evidence of disease recurrence, underscoring the potential of PDT as a viable treatment option for this rare manifestation of BD., Competing Interests: Declarations of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Little is known about prognostic factors that may influence the response to non-invasive treatments of patients with Bowen's disease. The aim of this study was to identify patient and lesion characteristics that are associated with a higher risk of treatment failure after 5-fluorouracil and photodynamic therapy in Bowen's disease. The hypothesis that the thickness of the Bowen's lesion and extension along the hair follicle is associated with the risk of treatment failure after noninvasive treatment was also explored., Methods: Data were derived from a non-inferiority randomized trial in which 169 patients were treated with 5% 5-fluorouracil cream twice daily for 4 weeks or 2 sessions of methylaminolevulinate photodynamic therapy with 1-week interval. All patients had histologically confirmed Bowen's disease of 4-40 mm. The initial 3 mm biopsy specimens were re-examined to measure the maximum histological lesion thickness and extension along the hair follicle. To evaluate the association between potential risk factors for treatment failure at 1-year follow-up, univariate and multivariate logistic regression analyses were used to calculate odds ratios (ORs) with 95% confidence intervals and p values., Results: Histological lesion thickness was not significantly associated with treatment failure (OR: 0.84, p = 0.806), nor was involvement of the hair follicle (OR: 1.12, p = 0.813). Lesion diameter was the only risk factor that was significantly associated with 1-year risk of treatment failure (OR = 1.08 per mm increase, p = 0.021). When using the median value of 10 mm as cut-off point, the risk of treatment failure was 23.4% for lesions >10 mm compared to 10.3% for lesions ≤10 mm (OR: 2.66, p = 0.028)., Conclusions: Only clinical lesion diameter was identified as a prognostic factor for response to non-invasive therapy in Bowen's disease., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Background: Randomized controlled trials comparing the effectiveness of 5-fluorouracil cream, methylaminolevulinate photodynamic therapy (MAL-PDT) and surgical excision in patients with Bowen's disease are lacking., Methods: In this multicenter noninferiority trial, patients with a histologically proven Bowen's disease of 4-40 mm were randomly assigned to excision with 5 mm margin, 5% 5-fluorouracil cream twice daily for 4 weeks, or 2 sessions of MAL-PDT with 1 week interval. The primary outcome was the proportion of patients with sustained clearance at 12 months after treatment. A noninferiority margin of 22% was used., Results: Between May 2019 and January 2021, 250 patients were randomized. The proportion of patients with sustained clearance was 97.4% (75/77) after excision, 85.7% (66/77) after 5-fluorouracil, and 82.1% (64/78) after MAL-PDT. Absolute differences were -11.7% (95% CI -18.9 to -4.5; P = .0049) for 5-fluorouracil versus excision and -15.4% (95% CI -23.1 to -7.6; P = .00078) for MAL-PDT versus excision. Both noninvasive treatments significantly more often led to good or excellent cosmetic outcome., Conclusions: Based on our predefined noninferiority margin of 22%, 5-fluorourcail is noninferior to excision and associated with better cosmetic outcome. For MAL-PDT noninferiority to excision cannot be concluded. Therefore, 5-fluorouracil should be preferred over excision and MAL-PDT in treatment of Bowen's disease., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Non-melanoma skin cancer (NMSC), which includes both Bowen's disease (BD) and superficial basal cell carcinoma (sBCC), is the most commonly diagnosed cancer in Canada. BD and sBCC are amenable to minimally invasive treatments however, large-scale studies assessing long-term outcomes are lacking, particularly regarding the timing and duration of non-invasive combination treatments., Objective: Examine the clinical cure rate of BD and sBCC using a combination treatment consisting of a single cycle of cryotherapy followed by a three to four-week course of topical 5-fluorouracil (5-FU)., Methods: Retrospective chart review at a single center. Inclusion criteria included histology-proven sBCC or BD treated with either a combination protocol, cryosurgery, or 5-FU alone., Results: 310 biopsy-confirmed cases of BD and 176 biopsy-confirmed cases of sBCC were analyzed. Of these, 229 cases of BD and 61 cases of sBCC were treated with cryosurgery and immediate 5-FU application, yielding a clearance rate of 90% and 86.9% at 6 months from initial treatment., Conclusion: Cryosurgery followed by immediate 5-FU use may be an effective mode of treatment for BD and sBCC, negating the need for invasive procedures and allowing for increased accessibility. Further studies with longer follow-up intervals, comparisons with other non-invasive treatments, and evidence of histologic cure are required. J Drugs Dermatol. 2023;22(12):1166-1171. doi:10.36849/JDD.7378.

Background: Photodynamic therapy (PDT) is used to treat cutaneous cancers. It may induce cell death through direct and indirect means, including apoptosis, inflammation and certain immune mechanisms, with the depth of penetration as a potential modifying factor., Objectives: To examine the pathways of apoptosis in the intralesional PDT of basal cell carcinoma (BCC) and intraepidermal squamous cell carcinoma (Bowen's disease)., Methods: Sixteen patients with superficial or nodular BCC and Bowen's disease were treated with intralesional aminolevulinic acid-PDT. Biopsies were taken at baseline and 24 h post-PDT, and sections were examined by immunohistochemistry for the expression of markers of apoptosis, such as caspase 3, involved in the intrinsic apoptotic pathway, granzyme B, a caspase-independent apoptotic mediator, and the proapoptotic markers BAX and BAK., Results: Apoptotic cells stained with TUNEL showed statistically significant staining at 24 h post PDT (p < 0.01 in both BCC and Bowen's lesions). Caspase 3 (p < 0.01 in BCC and p < 0.05 in Bowen's) and granzyme B (p < 0.01 in BCC and p < 0.01 in Bowen's) were significantly increased at 24 h post-PDT. BAX expression was apparently increased compared to baseline in Bowen's lesions at 24 h post-PDT, whereas Bak was upregulated both in BCC and Bowen's disease at baseline and at 24 h post-PDT., Conclusion: Intralesional PDT induces apoptosis in BCC and Bowen's disease via common and alternative apoptotic pathways involving granzyme B. Proapoptotic factors Bak in both BCC and Bowen and Bax in Bowen's disease appear to increase by intralesional PDT at 24 h., (© 2023 European Academy of Dermatology and Venereology.)

Photodynamic therapy is a powerful tool in the localized and selective treatment of dermatologic diseases, such as actinic keratosis, acne vulgaris, Bowen's disease and basal cell carcinoma. The success of photodynamic therapy is mainly attributed to the development of flexible light sources for homogenous and reproducible illumination during clinical studies. The essential requirement for this therapy includes, a suitable photosensitizer, presence of oxygen and a light of specific wavelength and intensity. The use of light emitting fabric comprising of optical fibers provides an exciting and an efficient way to transfer light directly to the skin uniformly on the infected body parts. As the optical fibers can transmit light from 400 to 1200 nm it is possible to combine light emitting fabric with laser sources for medical applications. This review focusses on the challenges and recent developments in the use of light emitting fabric for photodynamic therapy in clinical studies and its future perspectives., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Keratinocyte skin carcinomas (squamous cell carcinoma, basal cell carcinoma [BCC], Bowen disease [BD]) inflict significant morbidity and constitute a treatment challenge in renal transplant recipients (RTR). Immunocryosurgery has shown efficacy >95% in the treatment of BCC and BD in immunocompetent patients. The present study evaluated the safety, feasibility and efficacy, of immunocryosurgery in the treatment of BCC and BD in a series of RTR. During a 3-year period, biopsy-confirmed cases of BCC and BD were treated with a standard immunocryosurgery cycle (5 weeks daily imiquimod and a session of cryosurgery at day 14). Safety was evaluated by comparing graft function markers between immunocryosurgery treated RTR patients and matched controls. Ten BCC (8 nodular, 1 basosquamous, 1 superficial; diameter 6-14 mm; mean 9.2 mm) and nine BD disease lesions in nine patients (7 men, 2 women; age range: 54-70 years, mean: 62.1 years) were treated with immunocryosurgery and followed-up for two to 5 years. Five BCC were located on the "H area" of the face. No patient showed clinical or laboratory signs of transplant dysfunction during treatment or follow-up. Seven out of 10 BCC lesions cleared completely after one 5-week immunocryosurgery cycle, two cleared after repeat and intensified treatment cycles and one responded only partially (clearance rate: 90%). Seven out of nine BD lesions cleared after one 5-week immunocryosurgery cycle and one lesion after two cycles (clearance rate: 88.9%). In conclusion, immunocryosurgery is a safe, feasible and effective minimally invasive treatment alternative to standard surgical modalities for BCC and BD in RTR., (© 2022 Wiley Periodicals LLC.)

Background: Although surgery is the treatment of choice for Bowen disease (BD) and cutaneous squamous cell carcinoma (cSCC), nonsurgical treatments such as photodynamic therapy (PDT) may be preferred for select tumors. Previous meta-analysis have failed to gather strong evidence to recommend PDT., Objective: This study evaluates the effectiveness of PDT in the treatment of cSCC and BD for clearance rate (CR) after 1 year., Methods: A literature search of studies of biopsy-proven BD and cSCC treated with PDT was performed. Pooled CRs were estimated. Subgroup analyses were performed based on follow-up, treatment regimen, lesion size, and site., Results: Forty-three studies were included, enrolling 1943 BD lesions and 282 SCC lesions. Pooled CRs for BD and SCC were 76% (95% CI: 71%-80%; I2 = 78.9%) and 51% (95% CI: 35%-66%; I2 = 85.7%), respectively., Conclusion: Our findings support the selective use of PDT for BD; however, patients should be advised of potential for recurrence. Although PDT can be used for certain cases of cSCC, the high rate of treatment failure necessitates close surveillance for residual or recurrent disease. Further studies are needed to justify the usage of PDT in the treatment of BD and cSCC., (Copyright © 2022 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

One of the key aspects of photodynamic therapy is the light source that is used to irradiate the lesion to be treated. The devices used must ensure that their emission spectrum matches the absorption spectrum of the photosensitizer, so that treatment radiation is delivered only on the target area, without irradiating healthy tissue at superficial or deep levels. Irradiance values must be adequate in order to avoid thermal damage, exceed the oxygen replenishment rate and avoid long treatment times. Furthermore, the device should be user-friendly, inexpensive, and able to be adapted to different photosensitizers. We have developed an easy-to-use and highly customizable device based on LED technology. Its innovative geometric design allows radiation to be delivered to a small treatment surface, since the LEDs are arranged in three arms, the configuration of which directs their radiation on the treatment point. Different high-power color LEDs are disposed on the arms, and can be independently selected based on the most effective wavelengths for exciting the different photodynamic therapy photosensitizers. We have tested the prototype in 5 different patients (1 actinic keratose, 1 actinic cheilitis, 1 superficial basal cell carcinoma and 2 Bowen's disease) and after 1-2 sessions of total cumulative dose of 25-50 J / cm2, 100% clearance of lesions were obtained. Our device can be used by any professional in the field, whether for medical or research purposes. It facilitates the development of treatment protocols and trials with different photosensitizers., (Copyright © 2022. Published by Elsevier B.V.)

Photodynamic therapy (PDT) is a licensed and established procedure for the treatment of actinic keratosis, basal cell carcinoma, and Bowen's disease, but there are several new and clinically relevant developments and trends. These concern on the one hand the main components of PDT, which are the photosensitizer and the light source. Furthermore, modifications and therapy combinations have been developed that lead to an improved therapeutic efficacy. An important aspect of field-directed PDT is also skin cancer prevention. Finally, PDT has been used successfully for nonlicensed indications including inflammatory diseases and skin rejuvenation. This article focuses on these new developments and on recent guideline recommendations.

Photodynamic Therapy (PDT) is a therapeutic modality used for several malignant and premalignant skin disorders, including Bowen's disease skin cancers and Superficial Basal Cell Carcinoma (BCC). Several photosensitizers (PSs) have been explored for tumor destruction of skin cancers, after their activation by a light source of appropriate wavelength. Topical release of PSs avoids prolonged photosensitization reactions associated with systemic administration; however, its clinical usefulness is influenced by its poor tissue penetration and the stability of the active agent. Nanotechnology-based drug delivery systems are promising tool to enhance the efficiency for PDT of cancer. This review focuses on PSs encapsulated in nanocarriers explored for PDT of skin tumors., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: This is a systematic review and meta-analysis on the effectiveness of Photodynamic Therapy (PDT) in Bowen's Disease (BD), with further summary of the data from all randomized controlled trials (RCTs)., Methods: Relevant data were extracted after conducting a literature search via PubMed, Embase, Scopus, the Cochrane Library, CNKI, and Wanfang databases, from inception until 31 July 2019. Meta-analyses of the data were performed using RevMan V.5.3. A total of 392 published RCTs related to the efficacy of PDT in BD treatment were identified. The papers were screened for duplicates and excluded based on title and abstract. Subsequently, 85 full-text articles were thoroughly reviewed and finally, data from 446 patients with 1147 skin lesions across 12 eligible studies were collated., Results: Our findings revealed significant differences between the efficacies of PDT and other treatments, where a higher lesion reduction rate was observed after the first treatment session following PDT (P < 0.00001, Z = 4.98). PDT was found to be more effective than 5-fluorouracil (P < 0.00001, Z = 4.42) and cryotherapy (P = 0.008, Z = 2.67). However, there were no significant differences in recurrence rates following treatments with PDT, cryotherapy, and 5-fluorouracil., Conclusions: This systematic review and meta-analysis confirms and collates data from all RCTs pertaining to the efficacy of PDT for BD treatment. Our study has reiterated that PDT is more effective than 5-fluorouracil and cryotherapy for the treatment of BD., (Copyright © 2020 Elsevier B.V. All rights reserved.)

We used 5-aminolevulinic acid-photodynamic therapy (ALA-PDT) combined with plum-blossom needle (PBN) on a 3.5 cm × 3.0 cm pretibial region to treat an elderly woman suffering from Bowen's disease (BD). Before the application of ALA, the PBN was inserted 3-4 times vertically starting at 5 cm above the lesion. Then, 20 % 5-ALA cream was applied with an incubation time of 3.5 h. A semiconductor laser at a wavelength of 635 nm was used to illuminate the lesion at 100 J/cm 2 using 60 mW/cm 2 . A total of three sessions of ALA-PDT were performed at 2-3-week intervals, thus removing the lesion of BD. However, a 1.5 cm × 1.0 cm ulceration occurred 2 weeks after the third session when the PBN was used. Therefore, PBN percussion or other methods for promoting ALA penetration should be carefully applied to avoid ulceration, especially on the sites with less subcutaneous tissue., (Copyright © 2020. Published by Elsevier B.V.)

Photodynamic therapy (PDT) is an important tool for the treatment of various cutaneous malignant and non-malignant diseases. This therapy involves the application of a photosensitizer to the affected area which is followed by illumination with the light of a particular wavelength resulting in the death of cancerous cells. This review encompasses a brief description of the mechanism of photodynamic therapy and different photosensitizers used clinically. However, the major obstacle with a majority of photosensitizers is its limited bioavailability and long-term photosensitivity which limits its use. To overcome these limitations different nanocarriers systems has been developed and studied for their efficacy in PDT, which forms the focal point of the review., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Bowenoid papulosis is a polymorphic papular disease that occurs on the external genital area. We investigated the efficacy of 5-aminolevulinic acid-mediated photodynamic therapyin the treatment of Bowenoid papulosis., Methods: We investigated 200 Bowenoid papulosis cases from the Department of Dermatology and Venereology of Nanfang Hospital in 2016-2018. Biopsies were performed from Bowenoid papulosis lesions before treatment. The patients were divided into two groups: 100 patients each in the 5-aminolevulinic acid-mediated photodynamic therapy and control groups(radiofrequency cauterisation, microwave ablation, and surgical resection groups). Differences in lesion clearance, recurrence rate, and patient satisfaction after treatment were evaluated., Results: Photodynamic therapy sessions for multifocal Bowenoid papulosis were more frequent than those for monofocal lesions. All lesions in the 5-aminolevulinic acid-mediated photodynamic therapy group were cleared after photodynamic therapy, with no recurrence at the 1-year follow-up; however, 20 (20.0 %) patients in the control showed recurrence after 1 year. Only 5patients in the photodynamic group were unsatisfied with the treatment cost and 34 patients in the control group experienced short-term pain and scarring. The recurrence rate was significantly lower (P < 0.05) and patient satisfaction was higher (P < 0.05) in the 5-aminolevulinic acid-mediated photodynamic therapy group than those in the control. The recurrence rate was significantly lower (P < 0.05) and patient satisfaction was higher (P < 0.05) in the 5-aminolevulinic acid-mediated photodynamic therapy group than those in the surgical resection group. The recurrence rate of lesions was significantly lower in the surgical resection group than that in the rest of the control group (P < 0.05). There was no difference in recurrence rate and patient satisfaction between the radiofrequency cauterisation and microwave ablation groups., Conclusions: 5-aminolevulinic acid-mediated photodynamic therapy for Bowenoid papulosis results in a low recurrence rate and high satisfaction., Competing Interests: Declaration of Competing Interest None., (Copyright © 2019. Published by Elsevier B.V.)

Keratinocyte carcinomas (KC) are the most common malignant human neoplasms. Although surgery and destructive approaches are first-line treatments, topical therapies are commonly used. Due to limited uptake of topical agents across the skin barrier, clearance rates are often sub-optimal. In pre-clinical investigations, ablative fractional laser (AFL)-assisted drug delivery has demonstrated improved uptake of topical drugs commonly used to treat KC. In 22 clinical trials, the effect of AFL-assisted treatments has been investigated for actinic keratosis (AK; n = 14), Bowen's disease (BD; n = 5), squamous cell carcinoma (n = 1), and basal cell carcinoma (n = 7). The most substantial evidence currently exists for AFL-assisted photodynamic therapy for the treatment of AK and BD. AFL improved 12-months follow-up clearance rates of photodynamic therapy from 45.0-51.0% to 78.5-84.8% for AK and from 50.0-55.3% to 87.0-87.5% for BD. AFL-assisted pharmacological therapy is a promising tool for optimizing topical treatments of KC and its precursor lesions. Future developments include AFL-assisted immune activation, changing drug administration route of systemic therapies, and utilizing drug chemo-combinations., Competing Interests: Declaration of Competing Interest AME has received a research grant from Leo iLab and equipment loan from PerfAction. UHO declares no conflicts of interest. MH has received research grants from Leo Pharma, Lutronic, Novoxel, Procter&Gamble and Sebacia, and received equipment or equipment loan from Cherry Imaging, Cynosure-Hologic, Lutronic, Novoxel and PerfAction. AMR has received research grants from Leo iLab, ASLMS, and the Skin Cancer Foundation, served as a consultant for Merz, Biofrontera, Dynamed, Canfield Scientific, Evolus, Quantia MD, Lam Therapeutics, Cutera, and Skinfix, sat on advisory board for Allergan Inc., received travel grants from Mavig and L'oreal, and received equipment loan from PerfAction., (Copyright © 2020. Published by Elsevier B.V.)

Topical photodynamic therapy (PDT) is a widely approved therapy for actinic keratoses, Bowen's disease (squamous cell carcinoma in situ), superficial and certain thin basal cell carcinomas. Recurrence rates when standard treatment protocols are used are typically equivalent to existing therapies, although inferior to surgery for nodular basal cell carcinoma. PDT can be used both as lesional and field therapies and has the potential to delay/reduce the development of new lesions. A protocol using daylight to treat actinic keratoses is widely practised, with conventional PDT using a red light after typically a 3-h period of occlusion employed for other superficial skin cancer indications as well as for actinic keratoses when daylight therapy is not feasible. PDT is a well-tolerated therapy although discomfort associated with conventional protocol may require pain-reduction measures. PDT using daylight is associated with no or minimal pain and preferred by patient. There is an emerging literature on enhancing conventional PDT protocols or combined PDT with another treatment to increase response rates. This guideline, published over two parts, considers all current approved and emerging indications for the use of topical PDT in dermatology, prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence., (© 2019 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

An observational study was carried out in the photodynamic therapy (PDT) section of Fuenlabrada's hospital (Madrid, Spain). Our goal was to investigate the efficacy and safety of PDT in Bowen's disease (BD). Between June 2011-June 2017 171 patients (191 lesions) with diagnosis of BD were enrolled in the study (95 women and 76 men; average age of 74.31 years). Lesions were treated with one 5-aminolaevulinic acid (BF-200 ALA)-PDT or methyl-5-aminolaevulinate (MAL)-PDT cycle of two sessions in one week. A second treatment cycle was performed in cases of clinical persistence at 12 weeks. Our results showed that 47/55 lesions were resolved (84.75%) after one or two ALA-PDT cycle and 75/136 lesions (55.15%) after one or two MAL-PDT cycles, in the 12-month follow-up. In conclusion PDT is a safe and non-invasive treatment option in BD. In addition, our results suggest a better response with ALA-PDT over MAL-PDT. Limits: observational study with a limited number of patients., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Photodynamic treatment with methyl aminolevulinate (MAL-PDT) is considered an effective and highly recommended treatment for Bowen's disease. However, its long-term efficacy remains to be established, as significant differences have been reported in this respect., Objective: The aim of the present study was to describe the results of a retrospective analysis of patients with Bowen's disease treated with MAL-PDT during the period 2006-17 at the Costa del Sol Hospital (Marbella, Spain)., Material and Methods: This study is based on a retrospective descriptive analysis of the clinical records of patients treated with MAL-PDT from June 2006 to September 2017. The analysis was based on calculating the mean and standard deviation values for the quantitative variables, and frequency distributions for the qualitative ones. The survival curves were plotted by the Kaplan-Meier method, and the log-rank test was used to assess differences in survival between groups. A cox regression analysis was performed to clarify the significant prognostic factors., Results: A total of 537 tumours with histologically confirmed Bowen's disease were treated with MAL-PDT. Recurrence-free survival at one year was 88%, and at 5 years, 71%. Tumour size >300 mm 2 (≥21 mm in diameter P = 0.019), its location in the upper extremities (P = 0.029) and patient's age <70 years (P = 0.028) were all associated with an increased risk of recurrence., Limitations: Given the retrospective design of our study, the possible existence of information bias cannot be ruled out., Conclusions: Although it is an appropriate treatment option for patients with Bowen's disease, MAL-PDT presents a risk of recurrence of almost 30% at 5 years. Larger lesions (>300 mm 2 ; ≥21 mm in diameter) are more likely to recur than smaller ones. Therefore, appropriate selection is needed of the tumour to be treated, and prolonged follow-up should be provided., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Bowen Disease (BD), also known as squamous cell carcinoma in situ, requires treatment to prevent progression to invasive cancer.. Photodynamic therapy (PDT) has been widely employed to treat BD. However, there are BD patients who undergo PDT but experience poor efficacy and recurrence. We have considered that for some, the reason is the depth of PDT penetrating tissue to be limited. Therefore, we combined simple shaving with PDT to treat 10 patients with a total of 44 advanced BD lesions. After local injection of anesthesia, the lesions were shaved once in situ, then a total of three PDT sessions were applied for each patient. At 12 weeks, all of BD lesions (100%) have shown complete clinical response. After more than 12 months follow-up, the RR was 0, and all lesions showed a good or excellent cosmetic outcome. The patient's symptoms were alleviated with improvement in the quality of life. For those with advanced BD, which are more than 3 cm in diameter, with unclear borders, ulcers, multiple occurrences and those that appear on the face and neck that are not suitable for extended resection by routine surgery, combined simple shaving with PDT is recommended., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Although surgical removal is the treatment of choice in Bowen's disease (BD), there are cases in which by age, comorbidities, use of anticoagulants, location, cosmetic result, or size, it is preferable to use other treatments such as cryotherapy, 5-fluorouracil cream, imiquimod 5% cream or photodynamic therapy (PDT). Efficacy of PDT in BD is supported by substantial research and clinical data., Objectives: This study aimed to evaluate the long term effectiveness of methyl aminolevulinate-PDT (MAL/PDT) on a wide range of Bowen lesions in different locations and sizes., Methods: Patients diagnosed with BD were treated in 3 sessions with a 4-week interval in between with MAL/PDT between January 2016 and January 2017 in a private clinic. Clinical response and relevant patient and tumour characteristics were analyzed during the first year after start of the PDT sessions., Results: In total, 21 BD lesions in 18 patients were included in the study. Complete regression (CR) after 3rd PDT session was 87.5% and 100% at the 6-month follow-up. Treatment was well tolerated and local adverse reactions were very scarce. No recurrence was observed at 12-month follow-up. Cosmetic outcome at 12 months was good or excellent in 100% of patients., Conclusions: MAL/PDT is an effective, non invasive and safe treatment modality for BD with excellent cosmesis., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Here, we present a case of arsenic-induced Bowen’s disease treated with a regimen consisting of topical 5-fluouracil and oral nicotinamide. The use of this therapy modality resulted in near complete resolution of all of the patient’s lesions except for those on her palms, soles, and scalp. Excellent wound care and treatment adherence were major factors contributing to the success of this treatment option. Our results ultimately provide an alternative approach to treating multiple arsenical keratoses in patients who are limited to a drug plan involving 5-FU and oral nicotinamide and who are able to be rigorously compliant with application of medication and wound care. J Drugs Dermatol. 2019;18(5):477-479.

Background: Aldara ® is a topical immunomodulatory treatment. The risks of systemic passage are minimal. There have been rare reports of systemic adverse effects., Patients and Methods: Case 1. Five sachets weekly of imiquimod were prescribed for Bowen's disease on the forearm in a patient known to have essential thrombocytosis under Hydrea ® . His CBC was normal (6000 leukocytes/mm 3 , 2200 PMN/mm, 230,000 platelets/mm 3 ). Imiquimod was given in 15 sachets weekly. Fifteen day later, the patient presented bicytopenia (3000 leukocytes/mm 3 , 1400 PMN/mm 3 , 119,000 platelets/mm 3 ). Hydroxyurea and imiquimod were suspended until normalization of CBC. Hydroxyurea was resumed without recurrence of the bicytopenia. The patient's history included an identical episode following application of imiquimod. Case 2. Five sachets weekly of imiquimod were prescribed for actinic keratosis on the scalp in a patient known to have primary polycythemia under hydroxyurea. Her CBC was normal except for anemia (Hb 11.5g/L, 160,000 platelets/mm 3 , 1100 lymphocytes/mm 3 ). Imiquimod was given in 12 sachets weekly. Ten days later, anemia increased (Hb 10g/dL) with lymphopenia (800/mm 3 ) and thrombocytopenia (115,000/mm 3 ). Suspension of imiquimod resulted in normalization of the previous CBC values., Discussion: . The literature review identified reports of dose-dependent lymphopenia under oral imiquimod but not under Aldara ® . The National Pharmacovigilance Database listed 10 cases of hematological disorders most likely caused by Aldara ® . Hydroxyurea may induce cytopenia, and while it was not considered the sole causative agent in this case, it is likely to have had a triggering role in these patients with blood dyscrasias. Our findings show that misuse of imiquimod carries a potential risk of hematologic abnormality in patients receiving concomitant hydroxyurea, a commonly combined drug., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Photodynamic therapy (PDT), using topically administered photosensitizing agents, is widely approved as a treatment for certain nonmelanoma skin cancers. As a tissue-sparing non-surgical modality, there is great potential for PDT to enhance the choice of therapies available to treat, and potentially prevent, skin cancer. Treatment-specific guidelines have assessed the evidence for various photosensitizing agents and light sources, dosimetry, and evaluate reported adverse effects. Discomfort is frequently experienced during treatment but no analgesia was required in most pivotal lesion-directed studies. Durability of response has been assessed with studies of PDT for basal cell carcinomas (BCC) extending to 5 years and beyond, 2 years for Bowen's disease and up to 1 year for actinic keratoses (AK). Disease-specific guidelines consider the place for topical PDT in routine clinical practice recognizing that PDT is typically office/clinic-based and usually initiated by specialists. Where updated guidelines are awaited, national and international consensus publications offer recommendations, including on the use of daylight to activate the photosensitizer for treating AK. Reviewed studies indicate equivalent efficacy of daylight PDT, but greatly reduced pain compared with conventional PDT. Guidelines and consensus publications also consider the place of PDT in treating skin lesions arising in organ transplant recipients and in the potential for PDT to delay/prevent the development of nonmelanoma skin cancers. There is now a substantial evidence-base to support the use of topical PDT in routine clinical practice with daylight PDT indicated for AK, providing suitable outside climate, whilst conventional PDT remains suitable for AK, Bowen's Disease, superficial and certain thin nodular BCC.

The aim of this review is to provide clinicians with an overview of outcomes in the current literature concerning the use of Photodynamic Therapy to treat Bowen's Disease, also known as Squamous Cell Carcinoma in situ. The review discusses clinical response, recurrence rates, cosmetic outcomes, and adverse effects. Strong evidence shows that PDT is an effective therapy for SCCis with acceptable clinical response rates and lower recurrence rates in comparison to conventional therapies such as cryotherapy and 5-fluorouracil. Furthermore, PDT is associated with superior cosmetic outcomes and is generally well tolerated by patients, with minimal side effects. PDT is especially useful in patients with multiple lesions and those whom are considered to be non-surgical candidates., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Bowen's disease (BD) is treated effectively with 5-aminolevulinic acid (ALA)-photodynamic therapy (ALA-PDT). Plum-blossom needling (PBN) may enhance topical drug delivery., Objective: To compare the effects of and adverse reactions to PBN and ALA-PDT of BD with those associated with ALA-PDT alone., Materials and Methods: Forty-three lesions from 24 patients were randomly assigned to 2 groups. The PBN-ALA-PDT group underwent vertical skin tapping with PBN before applying 10% ALA cream and narrow-band light-emitting diode irradiation (λ = 633 ± 10 nm; 100-200 J/cm). The ALA-PDT group received ALA cream and irradiation only., Results: At 6 weeks, the PBN-ALA-PDT and ALA-PDT groups achieved complete response (CR) rates of 77.78% (14/18 lesions) and 40% (7/20 lesions), respectively, (p < .05), and 2/18 and 10/20 lesions, respectively, achieved CRs after further treatment; 2.9 ± 0.8 sessions and 3.4 ± 0.7 sessions, respectively, were required for the lesions to achieve CRs. The PBN-ALA-PDT group required fewer treatment sessions and had higher protoporphyrin IX fluorescence levels (p < .05)., Conclusion: Plum-blossom needling may improve the efficacy of ALA-PDT by enhancing ALA delivery for BD treatment.

It is very rare that multiple Bowen's disease (BD) and basal cell carcinoma (BCC) lesions develop in a single patient. Routine therapy for the multiple lesions is not satisfactory. The present authors report on a patient who had developed multiple BD and BCC lesions for 12 years after arsenic trioxide treatment for his acute promyelocytic leukemia 20 years before. The patient with multiple lesions was successfully treated with photodynamic therapy., (© 2018 Wiley Periodicals, Inc.)