At Skincanceronly we use photodynamic therapy (PDT) as a treatment for field actinic keratoses. That is, we use it to treat an area of skin that is badly sun damaged. The commonest area we treat is the face. Other areas that are treatable include the hands, décolletage (upper chest), scalp and legs, We use a dedicated field light specifically designed for this treatment purpose.
The treatment takes place entirely at our surgery. There are four stages to the treatment:
1) The skin is prepared and cleaned ready for therapy. There is a range of medical skin products that may be required for a few weeks prior to PDT.
2) An expensive light activated lotion is applied to the region.
3) The patient then waits for under 4 hours for the light sensitizing cream to be absorbed into the skin and have effect.
4) The patient then has the treatment area subjected to a dedicated light beam for a specified accurate length of time. The machine has an inbuilt timer to ensure the correct dose.
The skin surface needs to be exposed to the air at the time. That is for PDT to work, the cream and the light and air are all needed.
When exposed to the light, the active ingredient destroys the abnormal precancerous and sun damaged skin cells.
A repeat treatment is organized 7 to 14 days later. Field actinic keratoses require two treatments over such a time course.
After the treatment?
After PDT it is vital that you look after the area that has been treated. The area cannot be exposed to excessive light. It is important to stay out of the sun for two days minimum post treatment and apply sun screen twice daily. If your face was treated, wear a broad brimmed hat whenever outside for the next two weeks. A post PDT treatment cream will help soothe the frequent hot and inflammed skin in the post treatment phase. The treated area will look and feel like it is sunburnt skin for a time. You will be supplied with a reminder handout following treatment.
Does it work?
PDT is a real alternative treatment for field actinic keratoses. The response is usually good but it does not always remove all sun damaged lesions in the region.
Follow up appointments are essential following PDT. At the follow up appointment, the doctor will look for any signs of recurrence or persistence of sun damaged lesions.
When patients have extensive sun damge but no actual skin cancers, PDT can be used to address this sun damage.
If patients also have skin cancers, we only use PDT on a region after established skin cancers have been treated. Often patients have had their skin cancers excised first. When there are no skin cancers left, PDT can be used to manage the background sun damaged skin.
After a period varying from months to years, a further treatment with PDT may be required.
Cost?
PDT is expensive and Medicare does not cover the treatment cost. Pharmaceutical benefits offers no assistance either. Treatment can lead to an out of pocket expense of many hundreds of dollars. The cream and the doctor’s equipment are both very expensive. For this reason, patients often elect to have alternate treatments that are covered by Medicare or by pharmaceutical benefits.
At skincanceronly we charge $400 for the first session and $300 for each subsequent session for our PDT for field actinic keratoses.The whole face can be treated as one field. As two treatments are required up to 28 days apart, the total cost for the two sessions is $700
Pensioners and veterans affairs patients can be treated for $200 per treatment session ($400 for two sessions). Remember neither Medicare nor Veterans Affairs offer to contribute towards the cost.
Some patients find the PDT cost no burden at all. They recount how many creams and potions they currently have in their bathroom to make their skin look healthier or younger. They sometimes tell us how many hundreds of dollars they have spent on goo that just does nothing. These patients often find PDT effective for their skin as well as very cost effective.
Side effects?
These can be a problem. It can be uncomfortable when the light is shining on the skin. Some patients can't tolerate it. Once the treatment is over, the area can be very red and weepy until it recovers. Sometimes the area develops a temporary crust. The "hip pocket" side effect is often the one that is greatest concern to our patients. We can't do much about the hip pocket side effect. The lotion and equipment is very expensive and Medicare makes no contribution.
Advantages?
PDT is safe and simple. The treatment time is quick. There is no need to apply ongoing creams at home. There is no concern about missing doses of long treatment course as there are only two treatments and they are both done at our Skincanceronly surgery. (Some existing creams require you to remember to apply them regularly for months).
A large field of skin can be treated at the same time. We can treat the whole face as one field.
The treatment is non invasive. There are no needles and there is no surgery involved.
Most patients end up pleasantly surprised at the excellent cosmetic result and the "younger" looking face that results.
Both scaly non pigmented sun damge and pigmented blotchy sun damage is treatable with PDT.