Metvix yields positive cosmetic results in basal cell carcinoma treatment

Key takeaways:

• The overall cure rate among patients that used Metvix following curettage was 90.3%.
• Adverse events were experienced by 18.3% of patients, particularly burning.

Topical photodynamic therapy and methyl aminolevulinate, marketed as Metvix, displayed effectiveness and good cosmetic outcomes in the treatment of basal cell carcinomas following surgery, according to a study.

The two types of treatment options for basal cell carcinoma (BCC) are either surgical or nonsurgical. Surgical excision, particularly electrodessication and curettage for low-risk BCC and Mohs micrographic surgery for high-risk BCC, continues to be the gold standard for treatment; however, outcomes do not always provide cosmesis.

On the other hand, photodynamic therapy combined with methyl aminolevulinate (MAL-PDT; Metvix, Galderma/Photocure ASA), is a topical solution that is superior to surgery in preserving skin integrity, according to the study.

“The goal of treating BCCs is to achieve a complete removal of the lesion while preserving cosmesis,” Shantel D.J. Lultschik, BHSc, of the Institute of Cosmetic and Laser Surgery in Oakville, Ontario, Canada, and colleagues wrote.

In this study, researchers examined the effectiveness, safety, satisfaction and cosmetic outcome of MAL-PDT after curettage and made recommendations for MAL-PDT as an alternative therapy.

This retrospective chart review included 278 patients (44.2% men; mean age, 57.24 years) that received MAL-PDT therapy following curettage. A total of 352 BCC lesions were treated, 17 (4.8%) of which were recurring.

Results showed that 90.3% of lesions were cured. The recurrence rate was 9.7%, with recurrences primarily occurring on the nose. In fact, after controlling for age, sex and type of lesion, those with nasal BCC were 2.82 (95% CI, 1.24-6.4) times more likely to experience recurrence after MAL-PDT treatment compared with those who experienced recurrence elsewhere.

Once all BCC lesions were removed from the nose, the cure rate increased to 92.9%. Of the 34 lesions that recurred after MAL-PDT treatment, 33 were considered nodular and a majority were referred to Mohs surgeons.

However, six patients elected to forgo Mohs surgery and continue with MAL-PDT therapy. Results showed that 50% of these patients remained clear.

Only 8.9% of the reviewed charts listed patient satisfaction; however, this data showed that 44% reported being happy with treatment, 56% reported being very happy and 0% reported dissatisfaction.

Limited cosmetic data also showed that 90.3% of patients had a good response, whereas 8.5% of lesions resulted in scarring. Adverse events were experienced by 18.3% of patients with the most common being burning in 19 patients.

The authors concluded by recommending surgery may be considered for nasal lesions, but all other lesions may be treated with MAL-PDT.

“Overall, MAL-PDT following curettage is an effective treatment modality for BCC lesions and can be incorporated into dermatology practices to provide patients with alternative options,” they wrote.