| Background:Skin carcinomas, especially the nonmelanoma skin carcinomas(NMSCs) usually appears at the naked parts of body, such as, head, face, neck and arm. The growth of tumor’s invasiveness will damage local tissues, thus bringing about the organic transformation and leading to disfigurement. At the early stage of skin malignant tumor, the adopting of treatment means, such as, traditional operations, freezing treatment, radiotherapy(RT) and chemotherapy(CHT) will get good effect. However, these treatments are traumatic and easy to form scars. In addition, after adopting these treatments, the shape of focus location can’t be restored effectively. But with the development of economy and society, people are putting more emphasis on beautiful appearance. The increasing morbidity of skin malignant tumors indicates that there are many demands to various treatments. And the choosing of treatments depends on the location of tumor, the degree of growth, margin and volume. The means of operation is the mainstream to cure skin cancer. Although operation is regarded as the standard method to cure nonmelanoma skin carcinomas, newer non-surgical means, directional key cells receptors or immunological reaction, such as, imiquimod, interferon(IFN) and 5-fluorouracial have greatly reduced the morbidity and mortality and improved the living quality of patients. Photodynamic therapy(PDT) is also proved that it can be used alone or matched with immunomodulator locally to cure the nonmelanoma skin carcinomas and tumors before deteriorating effectively.People are looking for a new treatment that has low morbidity, no pains, no side effect and can’t bring about drug resistance reaction after comprehensive treatment to cure tumors. How to meet the demands of patients who have malignant skin tumor for treatment is one of the challenges confronted by clinical medicine. And photodynamic therapy is just a kind of treatment that is needed. As a new kind of treatment, photodynamic therapy has better selectivity, which not only can’t damage the normal cells, but also is not limited to the location and size of skin lesion. Besides, photodynamic therapy can resist treatment for several times and can’t bring about drug resistance reaction and also can’t form scar. So, this kind of treatment has been widely applied into the treatment of nonmelanoma skin carcinomas and even becomes one of the standard treatments. In China, more and more doctors have adopted this treatment to treat the patients who have skin tumor, especially those middle-aged patients. The purpose of this research is to evaluate the effectiveness and security of local ALA photodynamic comprehensive treatment when treating malignant skin tumor, and the function of it at the aspect of improving operation.Materials and Methods:1. Local ALA photodynamic treatment is used to the research of treating Extramammary Paget’s disease(EMPD), and there are 38 patients who have been diagnosed as EMPD. The age range of these patients is among 55-87, and the course of disease is among 9 months to 15 years. The location of focus is penis and scrotum. The diameter of focus of 23 patients is less than 8cm; 9 patients is 4-6cm and 6 patients is larger than 10 cm. Among these patients, 31 patients have accepted lesion resection operation and have ALA photodynamic treatment later. Due to great operating difficulty or the refusal of patients, 7 patients have only accepted ALA photodynamic treatment and didn’t have operation. ALA photodynamic treatment has adopted laser whose wave length is 635 nanometer to radiate every tumor focus for 15 minutes, with radiating density of 120 J/cm2. After 6 months or within a year of treatment, we have launched investigations about effectiveness and the satisfaction of patients, which includes reaction of focus and the effectiveness at the aspect of shape. The result has used statistical software SPSS 13.0 to analyze.2. The research of local ALA photodynamic treatment used to treat basal cell carcinoma(BCC): 69 patients(male: 45; female: 24) have been diagnosed as BCC, among which 42 patients’ tumor belongs to superficial type, 27 patients’ tumor belongs to nodular type and the result of CT indicates that there is no obvious lymphatic metastasis. All of these patients are among 48-92 years old, and the course of disease is among 13 months to 18 years. 38 patients have their focus location on the face; 11 patients at the inner eye corner; 3 patients on the head and 17 patients at the tempus. The diameter of focus of 23 patients is less than 2cm; 32 patients is 3-4cm and 14 patients is larger than 5cm. 55 patients have accepted lesion resection operation and have ALA photodynamic treatment later. 14 patients have only accepted ALA photodynamic treatment and didn’t have operation.3. The research of local ALA photodynamic treatment used to treat squamous cell carcinoma(SCC): 15 patients(male: 7; female: 8) have been diagnosed as SCC, and the result of CT indicates that there is no obvious lymphatic metastasis. All of these patients are among 60-100 years old, and the course of disease is among 15 months to 17 years. 5 patients have their focus location on the scalp; 7 patients in the face; 2 patients in the neck and 1 patient at the back of the hand. The diameter of focus of 5 patients is less than 2cm; 7 patients is 3-4cm and 3 patients is larger than 5cm.11 patients have accepted lesion resection operation and have ALA photodynamic treatment later. 4 patients have only accepted ALA photodynamic treatment and didn’t have operation.4. The research of local ALA photodynamic treatment used to treat Bowen’s disease(BD): 27 patients(male: 18; female: 9) have been diagnosed as BD, and all of these patients are among 57-82 years old, and the course of disease is among 10 months to 19 years. 18 patients have their focus location in the head and face; 3 patients in the arms; 1 patient in the body and 5 patients on the genitals. The diameter of focus of 15 patients is less than 5cm; 4 patients is 5-8cm and 8 patients is larger than 10 cm. 20 patients have accepted lesion resection operation and have ALA photodynamic treatment later. 7 patients have only accepted ALA photodynamic treatment.Results:1. Combined treatment group. The visible focuses of 21 patients have been completely removed, and due to the special parts of the tumor(such as, scrotum, penis and so on), the tumors of 10 patients are partly removed. After three-time photodynamic treatment, the focus on the skin vanished thoroughly. After 6 months’ treatment of combined treatment group, there were no relapse cases, and after 1 year’s follow-up visit, there were 9 relapse cases, with a total morbidity of 29.03% within one year. After four to six-time photodynamic treatments, the focuses on skin of single treatment group also vanished thoroughly. And after 6 months of treatment, there was 1 relapse case, with a total morbidity of 14.29%. In the following year, there were 3 relapse cases, with a total morbidity of 42.86%. All patients have finished the whole course of treatment, and their shapes are good after operation and there are no any side effects.2. Combined treatment group. The visible focuses of 46 patients have been completely removed, and due to the special parts of the tumor(such as, the corner of eye, lid margins and so on), the tumors of 9 patients are partly removed. After three-time photodynamic treatment, the focus on the skin vanished thoroughly. After 6 months’ treatment of combined treatment group, there were no relapse cases, and after 1 year’s follow-up visit, there were 2 relapse cases, with a total morbidity of 3.64% within one year. After four to six-time photodynamic treatments, the focuses on skin of single treatment group also vanished thoroughly. And after 6 months of treatment, there was 1 relapse case, with a total morbidity of 7.14%. In the following year, there were 3 relapse cases, with a total morbidity of 28.57%.3.Combined treatment group. The visible focuses of 8 patients have been completely removed, and due to the special parts of the tumor(such as, eyes and so on), the tumors of 3 patients are partly removed. After three-time photodynamic treatment, the focus on the skin vanished thoroughly. After 6 months’ treatment of combined treatment group, there were no relapse cases, and after 1 year’s follow-up visit, there were 4 relapse cases, with a total morbidity of 36.36% within one year. After four to six-time photodynamic treatments, the focuses on skin of single treatment group also vanished thoroughly. And after 6 months of treatment, there were 3 relapse cases, with a total morbidity of 75%. After one year of treatment, all patients of combined treatment group are satisfied with the treatment outcome, while in the single treatment group, there are 3 relapse cases and they are not satisfied with the treatment outcome.4. Combined treatment group. The visible focuses of 18 patients have been completely removed, and due to the special parts of the tumor(such as, the corner of eye, lid margins and so on), the tumors of 2 patients are partly removed. After three-time photodynamic treatment, the focus on the skin vanished thoroughly. After 6 months’ treatment of combined treatment group, there were no relapse cases, and after 1 year’s follow-up visit, there was no relapse case. After four to six-time photodynamic treatments, the focuses on skin of single treatment group also vanished thoroughly. And after 6 months of treatment, there was 1 relapse case, with a total morbidity of 14.29%. In the following year, there were 2 relapse cases, with a total morbidity of 28.57%.Conclusion:As a kind of adjuvant therapeutic method of skin tumorectomy, photodynamic treatment can reduce the excision extension of tumor fo cus and the recovery of shape is much better. As other therapeutic method of traditional operation to cure tumor, photodynamic treatment can be used exclusively and it plays an important role in the treatment of tumor which is difficult to remove by operat ion. But whether it can reduce the morbidity or not is still needed to explore. In addition, with the advent of more and more effective therapeutic and lighting fixture, the photodynamic treatment of tumor will play a more important role in the field of treatment of malignant skin tumor. |
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