Daylight photodynamic therapy for the management of actinic cheilitis
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ORIGINAL PAPER
Daylight photodynamic therapy for the management of actinic cheilitis Dimitrios Andreadis1 · Achilleia ‑Maria Pavlou1 · Efstratios Vakirlis2 · Eleftherios Anagnostou1 · Fotini Vrani2 · Athanasios Poulopoulos1 · Alexandros Kolokotronis1 · Dimitrios Ioannidis2 · Elena Sotiriou2 Received: 8 December 2019 / Accepted: 30 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Early identification and adequate treatment of actinic cheilitis (AC), which affects the lower lip vermillion and is considered a precursor of squamous cell carcinoma, is mandatory. Photodynamic therapy (PDT) has been successfully used in AC. PDT with the use of daylight (DLPDT) is equally effective and more convenient than the conventional PDT. Data on short and long-term efficacy of DLPDT in AC are limited. Our primary purpose was to assess efficacy of DLPDT in AC as well as safety and tolerance. Twenty-two individuals with histologically confirmed AC received 2 MAL (5-aminolevulinic acid)-DLPDT sessions 1 week apart. Patients were evaluated clinically 3, 6, and 12 months after treatment. Non-complete responders were biopsied and excluded from the study if histological alterations were indicative of AC. Adverse events were recorded from baseline to the end of the 12-month follow-up period. Twenty patients completed the study. Overall, complete clinical response 12 months after treatment was 80% (16/20), while an association between treatment response and grade of dysplasia was observed (p = 0.016). With respect to response by grade, complete clinical response achieved in grade I AC was 100% (12/12) and 50% (4/8) in grade II AC. Main adverse events included mild erythema, oedema, and scaling, with no pain associated with DLPDT. According to our results, DLPDT seems to be of significant benefit for the treatment of grade I AC. Combination with the other treatment modalities could improve the efficacy in grade II AC. Further studies are needed for the assessment of late recurrences. Keywords Actinic cheilitis · Daylight photodynamic therapy · Photodynamic therapy · Daylight
Introduction Actinic cheilitis (AC) is a potentially malignant clinical entity [45] presenting as the equivalent of actinic keratosis (AK) at the lip vermilion. Excessive UV radiation is a major risk factor for the development of AC. The disease mainly involves the lower lip vermillion of fair-skinned individuals who are exposed to sunlight for prolonged periods of time, mostly for professional reasons [17, 34]. AC is considered a precursor of squamous cell carcinoma (SCC), since it is reported to progress into invasive SCC in 3.2–16.9% of the * Dimitrios Andreadis [email protected] 1
Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
2
cases [5, 10, 26, 29]. SCC of the lip metastasizes more frequently than SCC of the skin [21]. In this context, early di
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