10. Topical treatments and photodynamic therapy
In addition to excisional surgery and the ‘destructive therapy’ approaches (cryotherapy and electrodessication and curettage), a number of treatment options are available for the management of superficial basal cell carcinoma (BCC), Bowen’s disease (cutaneous squamous cell carcinoma in situ) and actinic (solar) keratosis (AK). These treatments include topical agents and photodynamic therapy.
The topical therapies covered in this guideline are imiquimod 5% cream, diclofenac 3% gel, 5-fluorouracil 5% cream and ingenol mebutate gel. Their effective use requires expertise and experience. Most are best used as 'field treatment' for areas with multiple AKs and have less utility for the treatment of specific keratinocyte cancers. However, imiquimod 5% cream is approved by the Therapeutic Goods Administration for the treatment of superficial BCC.
Photodynamic therapy involves the use of light to activate a photosensitiser localised in diseased tissues, resulting in the formation of cytotoxic reactive oxygen species. Photodynamic therapy is used in the treatment of AK, Bowen's disease, and BCC.
Topics covered in this section include: