Case discussion: How would you treat this patient? [29 November]

A few weeks ago, on 11 October, I shared the case of an elderly man with biopsy-proven nodular BCC, whose skin, circulation, and general medical condition made surgery “unwise”. I shared how I planned to do a gentle curette (of the tumour only) and then use ALA and PDT to treat his lesion.

Here is the previous images/discussion.

Below are three images showing where we are up to. These follow ALA / PDT plus LED to promote wound healing for two weeks.

Am I making progress? What next?

case discussion

– Prof David Wilkinson

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7 comments on “Case discussion: How would you treat this patient? [29 November]

  1. I don’t know what ALA snd LED stand for.

    The lesion is doing well but still two small ulceration and some white lines. Maybe freezing or another gentle currette with electrocautery as saw one doctor doing so and said it works.

  2. All I can say is it healing but I can interpret the dermoscopy
    I have a rule and I made it up, so it who knows?
    I dont look at anything with a dermoscope , within 4 weeks of treatment ,(esp after N2 )because I cant tell what is an inflammatory response. So with new vessels, it always seems to look bad and I start to doubt if it was a BCC.
    So far so good, look again in 4 weeks . Persistent ulcer is ominous.
    I don’t have access to PDTand LED, so how would we feel if used Imiquimod off label for the same purpose. Thanks

  3. Thanks for the comments. A reminder, this patient had biopsy-proven nodular BCC. He is a very poor candidate for surgery / destructive treatments – multiple comorbidities, anticoags, paper thin skin, no pulses. PDT is PhotoDynamic Therapy and ALA is AminoLevulenic Acid – the active drug for PDT. Its use in low risk BCC is not off label. Neil makes a good point about how challenging dermosocpy is in healing lesions like this; the positive is that there are no typical nBCC vessels, and this lesion is healing rapidly. (I saw him again today and it is almost resolved completely clinically). The point of this case is to always seriously consider non-surgical / non-destructive options, in the right situation/s

  4. Nice case.
    What is next ?? I guess follow-up. As it`s a low risk BCC, 6 months seems reasonable timeframe(?) Maybe an earlier check in 4 weeks to confirm it`s fully healed.

  5. Imiquimod :I was wondering about it because I do note some doctors are using this for low risk BCC if inadequate excision or local reoccurance. Is it a reasonable alternative in this sort of setting ? Ta