Neoadjuvant photodynamic therapy may facilitate surgical interventions

Neoadjuvant photodynamic therapy before surgery for squamous cell carcinoma in situ may facilitate simpler surgical interventions, according to a presentation at the American Society for Dermatologic Surgery annual meeting.

“Multiple treatments have demonstrated efficacy in cutaneous squamous cell carcinoma in situ (SCCis). ... Photodynamic therapy (PDT) for SCCis leads to an initial complete response rate of 77.9%,” Jake X. Wang, MD, of the department of dermatology at Yale University School of Medicine, and colleagues wrote. “SCCis may still benefit from the use of PDT as neoadjuvant therapy prior to definitive surgery if initial complete response is not achieved.”

In a retrospective review, 19 cases of SCCis without an initial complete response after PDT were analyzed. Researchers reviewed definitive treatments after PDT and compared lesion sizes before and after surgical intervention.

Of 13 cased treated with surgical intervention, five cases had a smaller surgical defect than the initial lesion; the average reduction in maximum diameter was 50.4%, with all cases exhibiting a partial response. In three cases with initially documented partial response to PDT, treatment was deferred, resulting in disease progression and surgery, with surgical defects larger than the original lesions. The remaining five cases that had definitive surgery had no response after PDT.

“In patients with broad SCCis and who are poor candidates for large procedures, neoadjuvant PDT prior to definitive surgery for SCCis may facilitate simpler surgical interventions with decreased morbidity,” Wang and colleagues wrote. “Close clinical monitoring is recommended in lesions with partial response to PDT when surgical intervention is deferred.”