Name of the Procedure:

Photodynamic Therapy (PDT) for Skin Lesions

Summary

Photodynamic therapy (PDT) is a treatment that uses a photosensitizing drug and a specific type of light to destroy abnormal cells. It is primarily used to treat pre-cancerous lesions on the skin and mucous membranes. During PDT, the drug is applied to the affected area and becomes activated by light exposure, which helps to eradicate the abnormal cells.

Purpose

PDT addresses pre-cancerous lesions on the skin and adjacent mucosa. The goal is to selectively destroy abnormal cells while minimizing damage to surrounding healthy tissue, reducing the risk of progression to skin cancer and improving skin health.

Indications

• Actinic keratosis (pre-cancerous skin lesions)
• Bowen's disease (squamous cell carcinoma in situ)
• Specific types of superficial basal cell carcinoma
• Field cancerization where multiple lesions are present or the skin is at high risk

Preparation

• Avoid sun exposure for 48 hours before the procedure.
• Discontinue photosensitizing medications if advised by a healthcare professional.
• Undergo a thorough skin examination to determine the extent of lesions.
• Clean the treatment area thoroughly before the procedure.

Procedure Description

1. Application of the Photosensitizing Drug: The physician applies a photosensitizing drug, usually in the form of a cream, directly to the affected area.
2. Incubation Period: The drug is allowed to penetrate the abnormal cells over a specified period, typically ranging from a few hours to 24 hours.
3. Illumination: The treated area is then exposed to a specific wavelength of light, activating the drug.
4. Destruction of Lesions: The activated drug produces a form of oxygen that kills the abnormal cells.
5. Post-Treatment Care: The area is cleaned and a dressing may be applied if necessary.

Tools and Equipment: Photosensitizing drug, light source (LED or laser), protective goggles for both patient and staff.

Anesthesia: Generally, local anesthesia is not required as the procedure is minimally painful, but a topical anesthetic may be applied if needed.

Duration

The entire process, from drug application to light exposure, typically takes between 1 to 2 hours. The light exposure itself usually lasts about 15 to 30 minutes.

Setting

PDT is usually performed in an outpatient clinic or dermatology office.

Personnel

• A dermatologist or specially trained physician
• Medical assistants or nurses

Risks and Complications

• Common: Redness, swelling, and a burning sensation at the treatment site.
• Rare: Infection, scarring, or changes in skin pigmentation.
• Management: Over-the-counter pain relief, cool compresses, and prescribed topical medications if necessary.

Benefits

• Non-invasive with minimal scarring.
• Targets abnormal cells specifically, preserving healthy tissue.
• Quick recovery with minimal downtime.
• Repeatable if new lesions develop.

Recovery

• Avoid direct sunlight and bright indoor lights for 48 hours post-treatment to prevent severe burns.
• Apply prescribed creams or ointments to soothe the treated area.
• The treated area may form a crust and heal within 7-14 days.
• Follow-up appointments may be scheduled to monitor progress.

Alternatives

• Cryotherapy: Freezing the lesions with liquid nitrogen.
• Surgical excision: Physically removing the lesions.
• Topical chemotherapeutic agents: Applying drugs like 5-fluorouracil. Pros and Cons: Cryotherapy and excision may be more invasive, with higher risks of scarring. Topical agents may require longer treatment duration.

Patient Experience

During the procedure, the patient might feel mild discomfort or a tingling sensation. Afterward, there can be some redness and swelling. Pain can typically be managed with over-the-counter medications, and patients generally return to normal activities within a few days, avoiding sun exposure strictly as instructed.