Images in Clinical Medicine
Fluorescence Diagnosis of Subclinical Actinic Keratoses
N Engl J Med 2008; 358:e21May 8, 2008
- Article
Photodynamic therapy is a noninvasive therapy for nonhyperkeratotic actinic keratoses and basal-cell carcinoma. Photodynamic therapy involves the activation of a photosensitizing drug by visible light to produce activated oxygen species within target cells, resulting in their destruction. Commonly used topical photosensitizers are aminolevulinic acid (ALA) and the methyl ester of ALA (MAL), which act as precursors of the endogenous photosensitizer protoporphyrin IX (PpIX). In addition to its therapeutic uses, fluorescence emitted by MAL-induced PpIX may be useful in providing a fluorescence diagnosis of cutaneous lesions. This permits the detection of otherwise occult areas of abnormal skin (Panel A). Tumor margins can also be delineated with the use of a Woods ultraviolet lamp before surgery, radiotherapy, or therapeutic illumination with a photodynamic-therapy lamp (Panel B). Areas of involved skin exhibit pink fluorescence in the presence of activated PpIX. In this 74-year-old man, an actinic keratosis was diagnosed on the basis of MAL, applied typically under occlusion on the scalp and forehead for 3 hours, and biopsy. Pathological examination of the involved skin revealed actinic keratosis. Photodynamic therapy was administered after the application of MAL with the use of 630-nm red-light irradiation for 8 minutes. Complete remission was achieved, with no recurrence at a 10-month follow-up visit.
Onofre Sanmartin, M.D.
Carlos Guillen, M.D.
Instituto Valenciano de Oncologia, E-46009 Valencia, Spain
osanmartinj@gmail.com - Citing Articles (3)
Citing Articles
1
Betty B. Chaar, Johnson Lee. (2011) Role of Socioeconomic Status on Consumers’ Attitudes Towards DTCA of Prescription Medicines in Australia. Journal of Business Ethics
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Nick van der Beek, Jaap de Leeuw, Claire Demmendal, Peter Bjerring, H.A. Martino Neumann. (2011) PpIX fluorescence combined with auto-fluorescence is more accurate than PpIX fluorescence alone in fluorescence detection of non-melanoma skin cancer: An intra-patient direct comparison study. Lasers in Surgery and Medicinen/a-n/a
CrossRef3
Max Schlaak, Jan C. Simon. (2009) Topical treatment of actinic keratoses with low-dose 5-fluorouracil in combination with salicylic acid - pilot study. Journal der Deutschen Dermatologischen Gesellschaft
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