Going Deeper With Photodynamic Therapy for BCC, With M. Shane Chapman, MD, MBA

Photodynamic therapy (PDT) has emerged as a non-surgical option for treating precancerous lesions and superficial basal cell carcinoma (BCC), offering patients another option in addition to excision with strong clearance rates and favorable cosmetic outcomes. While its use in the United States (US) is relatively new, international experience—particularly in Europe and South America—has long demonstrated its utility in clinical practice. These regions, where surgical resources may be more limited, have relied on PDT for years, generating a wealth of data on efficacy, technique, and patient outcomes.

That global experience is now informing U.S.-based research and clinical decision-making. One recent study conducted evaluated red light PDT with 10% 5-aminolevulinic acid (ALA) gel, which was approved by the US Food and Drug Administration (FDA) in 2016, in a randomized, double-blind, vehicle-controlled, pivotal phase 3 study across 21 centers in the U.S.1,2 The study found that, in 145 participants, those receiving 10% ALA gel had a 75.9% histological clearance rate and an 83.4% clinical clearance rate compared with 19.0% and 21.4%. respectively, in those receiving vehicle (both P <.0001).2

HCPLive spoke with study investigator M. Shane Chapman, MD, MBA, Chair, Department of Dermatology, Dartmouth Health, and Professor of Dermatology, Geisel School of Medicine, Dartmouth University, to learn more about questions that remain with PDT's use and further research trying to optimize it for skin cancer.

Chapman discussed the wide variation that clinicians currently employ with PDT usage, including in incubation time, light source selection, and treatment cycles. Other questions remain around the optimal activation schedule, whether red light, blue light, or combinations are most effective, and how PDT can be paired with other topical or systemic therapies. He stressed that his team is looking into measuring aminolevulinic acid (ALA) uptake in tissue that may eventually personalize treatment intervals, while collaborations with biomedical engineers are further refining light delivery and depth of penetration.

"I'm glad this study got done, and I'm glad we're finding out these different ways to use PDT and using it for superficial BCC, but I think we're very early in the course of PDT, and I think there's a whole lot more to do with it," Chapman said.

References

1. Ameluz FDA Approval History. Ameluz. Webpage. https://www.drugs.com/history/ameluz.html

2. Schlesinger T, Chapman MShane, Tu JH, et al. Red light photodynamic therapy with 10% aminolevulinic acid gel showed efficacy for treatment of superficial basal cell carcinoma in a randomized, vehicle controlled, double-blind, multicenter phase III study. J. Am. Acad. Dermatol. Published online August 2025. doi: 10.1016/j.jaad.2025.08.031