Download Photodynamic Therapy - Salford Royal NHS Foundation Trust

Photodynamic Therapy
Barnes Building
Photobiology Unit
0161 206 4081
© G17050501W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2017.
Document for issue as handout. Unique Identifier: CS28(17). Review date: May 2019
This guide has been
written to help answer
some of your questions
about photodynamic
therapy. You have been
given this guide because
photodynamic therapy
is one of the treatment
options for your skin
disorder.
What is photodynamic
therapy?
Photodynamic therapy (often
shortened to PDT) is a fairly
new treatment that is used
to treat skin lesions. PDT
involves applying a cream called
Metvix™ to the lesion. The
cream contains a chemical that
soaks into the skin. Once in the
skin this chemical is converted
into the active ingredient. The
active ingredient makes the
skin sensitive to light. It takes
about three hours for this to
happen. After three hours red
light is shone onto the area, this
switches the active ingredient
on and causes the cancer cells to
die.
When is PDT used?
In the UK PDT has been
licensed to treat three types of
skin lesions; actinic keratosis,
Bowen’s disease and superficial
basal cell cancer (often
shortened to BCC).
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Actinic keratosis
Basal cell cancer
Actinic keratosis is a skin
condition caused by many
years of sun exposure. The
actinic part of the word means
involving sunlight and the
keratosis part means scaly.
Actinic keratosis causes small
rough patches of skin to
develop on areas that have
been exposed to the sun.
Actinic keratosis is not a skin
cancer but it can develop into
one so it is a good idea to keep
an eye on it and have treatment
if your doctor recommends it.
BCC is one of the most common
forms of skin cancer. Most are
slow growing and almost never
spread to other parts of the
body. If left untreated they
can damage the skin and cause
an ulcer sometimes known as a
rodent ulcer. The thinner types
of BCC respond well to PDT;
these are known as “superficial
BCC”.
Bowen’s disease
Bowen’s disease is named after
Dr Bowen who discovered the
disease. Bowens disease is a skin
growth on the outer layers of
the skin. It can look like a red
scaly patch. Bowen’s disease
can turn into skin cancer so it is
a good idea to keep an eye on
it and have treatment if your
doctor recommends it.
© G17050501W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2017. Document for issue as handout.
Unique Identifier: CS28(17). Review date: May 2019.
2
What are the benefits of
PDT?
PDT is a safe out-patient
treatment for skin lesions. The
quality of skin healing is as good
as or better than some of the
other treatments available. This
can be important if your lesion
is on a “difficult to heal” site.
Several lesions can be treated
at once and PDT can be used
when larger lesions need to be
treated. A lesion can be retreated several times with PDT.
What are the risks of PDT?
PDT can cause pain during
treatment. The treatment site
can swell and become red and
crusty. This usually heals within a
week, but can take up to 4 weeks.
There is a chance that the
lesion may recur and further
treatments may be required.
Although the quality of healing
is generally very good there may
be changes in skin colour at the
lesion site following treatment.
The skin may heal to a different
colour than the surrounding
skin and there may be the
occasional risk of scarring.
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As with all treatments there is a
risk of infection.
What are the alternatives
to PDT?
There are a range of treatments
available for actinic keratosis,
Bowen’s disease and superficial
basal cell cancer. In some cases
curettage (scraping the lesion
away) or surgery has been used.
Chemotherapy skin creams such
as 5-Fluorouracil have been
used as has aldara cream. Other
treatments such as cryotherapy
(freezing) have also been used.
Is no treatment an option?
Actinic keratosis has the potential
to change into skin cancer. It is
possible to not treat the lesions
and to watch carefully to check
that no changes occur. If you
decide against treatment you
should go back to your doctor
again if any further changes
occur. Both Bowen’s disease
and BCC should be treated since
they can cause significant health
problems if left untreated.
What is the step by step procedure for PDT?
Step 3
Step 1
The surface of the skin will be
gently roughened to remove
any loose scales or crust. This
light scraping will be done with
a sharp edged tool such as a
scalpel blade or a curette.
We will put a dressing over the
lesion. The cream has to stay
on the lesion for 3 hours. The
dressing will help keep the
cream in place. During this time
you can leave the building but
you must come back within 3
hours.
Step 2
Step 4
The cream will be put onto the
lesion. A spatula will be used
to do this. You might feel a
slight stinging when the cream
is put on.
After 3 hours we will remove
the dressing and the cream. We
will wipe the area clean using
saline.
© G17050501W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2017. Document for issue as handout.
Unique Identifier: CS28(17). Review date: May 2019.
4
Step 5
Step 6
Step 7
We will now shine a bright red
light on the lesion. This is not
a laser. It may take a couple of
minutes to make sure the lamp
is in the right position. We will
give you some goggles to wear
as the light can be very bright
on the eyes
The lamp will be switched on
and the light will shine onto
the lesion for between 8 and
10 minutes. Some patients find
that when the light is switched
on they feel some pain. This has
been described as a burning
or prickling sensation. Not all
patients find the treatment
painful but if you do we can use
cooling air which can provide
relief. If the treatment does
become too uncomfortable
for you then the specialist can
pause the treatment for a short
while. If necessary the doctor
can give you a local anaesthetic.
After we have treated the
lesion we will apply a dressing.
This dressing will stop any light
shining onto the area we have
treated. The dressing should be
kept on the lesion for 2 days.
Very occasionally the area
may become infected and
you may need to contact the
photobiology unit or your
family doctor for anti-biotic
treatment.
Aftercare
The doctor will explain how you
should look after the area after
treatment.
Generally you should keep the
treated area covered after light
treatment and do not expose
it to sunlight or intense light
for 2 days as it might result in
burning reaction.
5
In some cases the treated area
will appear pink, swell a little
or ooze slightly. This is also
normal and shows a stronger
treatment action. This will
usually settle down within a day
or so. If oozing persists then
keep it covered with dressings
until it becomes dry.
After 1 to 2 days you can wash
bathe or shower as usual. Do
not however rub the treated
area but gently dab it dry. It is
best to avoid swimming until
the area is fully healed
After treatment pain and
itching may occur and can last
for a few days. If you feel
stinging or burning following
treatment then take two
paracetamol if needed.
© G17050501W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2017. Document for issue as handout.
Unique Identifier: CS28(17). Review date: May 2019.
6
Important information
Metvix™ cream contains peanut
oil. You should not have this
treatment if you are allergic to
peanuts or soya.
Metvix™ cream should not
be used if you have Porphyria
(a disorder of porphyrin
metabolism)
Treatment with Metvix™ is
not recommended during
pregnancy. If you are
breastfeeding this should be
stopped during and for two
days following treatment
If you are being treated with
UV therapy this should be
stopped before treatment with
Metvix™
Avoid getting Metvix™ cream
into your eye
There is no experience of
treating children below 18 years
with Metvix™ PDT.
This type of PDT is not suitable
for morpheaform, nodular or
pigmented BCC’s.
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Possible side effects
Pain
Painful and burning skin
sensations are the most
common side effect reported in
6 out of 10 patients in clinical
trials. These side effects are
generally described as mild to
moderate but in some cases can
lead to the treatment being
stopped. In addition to pain
the area treated may appear
red, swollen and/or crusty.
These symptoms will disappear
and have generally gone within
four weeks.
Scarring
You may be left with some
scarring at the site where your
lesion was. The skin may heal
to be a slightly different colour
than the surrounding skin. It
may be darker or lighter.
Follow up
Infection
There is a risk that the
treatment area may become
infected. We will be very
careful to try to ensure that this
does not happen but there is
always a risk that it may. If you
suspect the area has become
infected see your GP.
Recurrence
You are advised to keep an
eye on the area that has been
treated. Treatments are not
always successful and there is
always a risk the lesion may
come back.
The PDT treatment is made up
of two visits separated by one
week. After the second visit
you will be sent a letter inviting
you to attend the dermatology
out-patients department for a
follow up appointment. This
is so that we can check on
the progress of your lesion to
make sure there is no sign of a
recurrence. At this follow-up
appointment :
If the doctor feels the lesion
has not completely gone she/
he may invite you back for
further PDT treatment
If the doctor feels the lesion
is responding well she/he may
invite you back for a further
follow up appointment, or
may discharge you from the
clinic
If the doctor feels your lesion
has not responded to PDT
she/he may recommend
another alternative type of
treatment
© G17050501W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2017. Document for issue as handout.
Unique Identifier: CS28(17). Review date: May 2019.
8
Contact us
The Photobiology Unit can be
contacted on:
0161 206 4081
or Email:
Photobiology.Salford@
srft.nhs.uk
Further information
Macmillan Cancer Support
provide information leaflets,
audio visual tapes and
information in other languages
about photodynamic therapy
and skin cancer disorders.
Macmillan can be contacted via
telephone on:
0808 808 0000
9am to 8pm, Monday to Friday
Their web site can be found at:
Notes
The British Association of
Dermatologists produces a series
of patient information leaflets.
They can be contacted at:
The British Association of
Dermatologists,
4 Fitzroy Square,
London
or if you have access to the
internet on their web site:
www.bad.org.uk
Cancer Help UK (part of Cancer
Research UK) has information
about photodynamic therapy,
actinic keratosis, Bowen’s
disease and superficial basal cell
cancer on their web site at:
www.cancerhelp.
canerresearch.org.uk
www.macmillan.org.uk
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© G17050501W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2017. Document for issue as handout.
Unique Identifier: CS28(17). Review date: May 2019.
10
© G17050501. Design Services
Salford Royal NHS Foundation Trust
All Rights Reserved 2017
This document MUST NOT be photocopied
Information Leaflet Control Policy:
Unique Identifier: CS28(17)
Review Date: May 2019
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used, please contact 0161 206 4081
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Equality Act we will make
‘reasonable adjustments’
to enable individuals with
disabilities, to access this
treatment / service.
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