Photodynamic therapy combined with surgery versus Mohs micrographic surgery for the treatment of difficult-to-treat basal cell carcinoma: a retrospective clinical study

Figures & data

Figure 1. The procedures of S-PDT. (A) Routine disinfection towels and local lidocaine anesthesia. (B) Superficial shaving with a scalpel or razor. (C) Electrocoagulation was used to stop bleeding. (D)Apply pressure dressing with gauze, sterile gloves, cotton pads, or bandages. (E) Red light with wavelength of 633 nm and power of 80mW/cm² was irradiated for 20 min. (F) Good postoperative recovery at 36 months follow-up.

Figure 2. Clinical and pathology pictures in MMS and S-PDT groups. (A,B) Clinical picture with one lesion before treatment and 12 mouth follow-up in MMS group. (C,D) Clinical picture with four lesions before treatment and 12 mouth follow-up in S-PDT group. (E,F) Pathology before treatment in both groups shows basal cell carcinomas with basal cell-like cell hyperplasia, cytoplasm, deep staining of the nucleus, nucleus, disordered arrangement (hematoxylin–eosin stain, original magnification ×100). (G) Pathological biopsies after 1 year of follow-up in MMS group and show scar tissue. (F) Pathological biopsies after 2 years of follow-up in S-PDT group and show scar tissue and no recurrent pathological features.

Table 1. Baseline characteristics in the S-PDT and MMS group.

Characteristics	S-PDT	MMS	P
Gender M/F	11/5	11/5
Age, years	66.4 (13.8)	57.7 (6.3)	.092
Duration
<10 years	12 (75%)	12 (75%)
≥10 years	4 (25%)	4 (25%)
Location of lesions			.176
Inside H-zone^a	41 (65%)	17 (100%)
Outside H-zone^b	7 (35%)	0
Number of lesions per person			.333
Single	12 (75%)	15 (94%)
Multiple	4 (25%)	1 (6%)
Histological type
Superficial	8 (17%)	2 (12%)
Nodular	38 (79%)	14 (82%)
Others	2 (4%)	1 (6%)
Tumor size			.422
≤15mm	28 (58%)	8 (47%)
>15mm	20 (42%)	9 (53%)

Data are mean (SD) or number (%).

^aInside H-zone included Nasal(21), Periorbital(14), Forehead(3), Cheek(10),Perioral(4), Tempus (4), Ears(2).

^bOutside H-zone including Neck(7).

Table 2. Therapeutic effects, DLQI and total treatment time.

	S-PDT	MMS	MD (95%CI)	P
Recurrence(≥36 months)				1.000
No	48 (100%)	16 (94.11%)
Yes	0	1 (5.88%)
Healing times, days				<.001
	17.9 (9.8)	7.5 (1.5)	MD5.04(5.40 to 15.47)
DLQI scores per person
Before	15.63 (3.56)	15.44 (2.06)	MD0.19(−1.88 to 2.25)	.854
After	0.88 (1.67)	3.44 (2.90)	MD2.56(0.86 to 4.27)	.016
Total treatment times per person, hours
	2.08 (0.65)	3.62 (1.07)	MD1.55(0.91 to 2.19)	<.001

Data are presented as mean (SD), or number (%). MD: mean difference; DLQI: Dermatology Life Quality Index.

Table 3. Cosmetic response to S-PDT and MMS at 12 months after treatment.

	S-PDT	MMS	P
Four-point scale, n (%)	Excellent/Good	Excellent/Good	.719
	21/17 (79.2)	4/9 (76.5)
	Fair/Poor	Fair/Poor
	8/2 (20.8)	3/1 (23.5)

Table 4. Total costs both in S-PDT and MMS group (Euro).

	Mean	95%CI	Median (Q25–Q75)	p
S-PDT(n = 17)	700	560–840	621 (504–882)	.003
MMS(n = 17)	1042	902–1183	869 (882–1285)

p value was calculated by Mann–Whitney test. p < .05 were considered statistically significant.

Figure 3. Clinical picture of two patients in S-PDT group. (A) Multiple basal cell carcinomas of the facial ministry in a 52-year-old woman. (B) Clinical photograph immediately after superficial shaving treatment. (C) Clinical photograph after a follow-up of 12 months. (D)Basal cell carcinoma of the right eye periphery in a 56-year-old woman. (E) Clinical photograph after simple excision and suturing. (F) Clinical photograph after a follow-up of 24 months.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.