Consensus recommendations for the treatment of basal cell carcinomas in Gorlin syndrome with topical methylaminolaevulinate-photodynamic therapy.

Background Patients with Gorlin syndrome develop multiple basal cell carcinomas ( BCC), for which treatment is often difficult. Methylaminolevulinate-photodynamic therapy ( MAL- PDT) is approved for the treatment of superficial and nodular BCCs in Canada and several European countries. Objectives To establish consensus recommendations for the use of MAL- PDT in patients with Gorlin syndrome. Methods The Gorlin consensus panel was comprised of 7 dermatologists who had treated a total of 83 patients with Gorlin syndrome using MAL- PDT. Consensus was developed based on the personal experience of the expert and results of literature review (on PUBMED using the keywords ' MAL' and ' PDT' and 'Gorlin' or 'naevoid basal cell carcinoma syndrome'). Results Consensus was reached among the experts and the literature review identified 9 relevant reports. The experts considered MAL-PDT a generally effective and safe therapy for treatment of BCC in Gorlin syndrome. For superficial BCC ( sBCC), all sizes can be treated, and in nodular BCC ( nBCC), better efficacy can be achieved in thinner lesions (<2 mm in thickness). MAL-PDT treatment schedule should be performed according to labelling although in individual cases, it may be adapted and performed on a monthly basis based on clinical assessment. Follow-up should be related to frequency of recurrence, and severity, number and location of lesions. Multiple lesions and large areas may be treated during the same session; however, adequate pain management should be considered. Conclusions MAL- PDT is safe and effective in patients with Gorlin syndrome. Utilization of these recommendations may improve efficacy and clearance rates in this population. [ABSTRACT FROM AUTHOR]