10.3 Topical treatments and photodynamic therapy: health system implications and discussion

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Clinical practice guidelines for keratinocyte cancer > 10.3 Topical treatments and photodynamic therapy: health system implications and discussion

Health system implications

Clinical practice

The updated recommendations do not represent any significant change from current clinical practice.


Experience and education of practitioners in the use of topical treatments is required. Specialised equipment and training are required for the use of photodynamic therapy (PDT). However, implementation of the updated recommendations is not likely to increase resource requirements for organisations or the Australian health system.

Barriers to implementation

No barriers to the implementation of these recommendations are envisaged.

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Unresolved issues

Based on current evidence, it cannot be ascertained whether or not the treatment of actinic keratoses with spot therapy or field therapy reduces subsequent risk of developing cutaneous squamous cell carcinoma (cSCC).

There are insufficient long-term data from well-designed studies investigating the use of ingenol mebutate gel in the treatment of keratinocyte cancers to guide patient selection.

Studies currently underway

Studies are underway comparing various formulations of photosensitisers, penetration enhancers and light sources to improve the efficacy and tolerability of PDT.

Clinical trials are underway evaluating CLL442, a new topical treatment for cSCC in situ.[1]

Future research priorities

Evidence for the use of ingenol mebutate gel for basal cell carcinoma (BCC) and cSCC is limited to small early-phase clinical trials with low response rates. Since the development program was halted for the use of ingenol mebutate gel for the treatment of either BCC or cSCC, further research in this area would be warranted.

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  1. Novartis Pharmaceuticals. Safety, Tolerability, and Efficacy Study of CLL442 in Patients With Cutaneous Squamous Cell Carcinoma in Situ (SCCis). [homepage on the internet] ClinicalTrials.gov; 2017 Nov 7 [cited 2019 Mar 4]. Available from: https://clinicaltrials.gov/ct2/show/NCT03333694.

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