Different pain sensations in photodynamic therapy of nodular basal cell carcinoma: Results from a prospective trial and a review of the literature

SummaryBackgroundPain is a major side effect of topical photodynamic therapy (PDT), a relatively new and non-invasive treatment for particular types of basal cell carcinoma (BCC). In this study, we sought to characterise in more detail the quality and intensity of pain associated with PDT. Furthermore, we studied if gender, tumour size and localization as well as different light sources with comparable wavelengths had an influence on the pain.MethodsA total of 64 nodular BCCs in 55 patients, of which 48 BCCs underwent preceding debulking, were treated with 5-aminolevulinic acid (ALA-PDT). Two metal halogen light sources were randomly used. Pain assessment was performed using a visual analogue scale (VAS).ResultsAll patients experienced pain during illumination and 41.8% after illumination. The mean pain intensity was 3.88 with most patients experiencing burning (82.5%) or stinging (36.8%) sensations. Illumination with the Medeikonos® light source was experienced less painful than the Waldmann® lamp (4.64 versus 3.40; p = 0.027). Gender as well as tumour localization and size did not alter the pain scores. Likewise, no differences were observed between patients who underwent debulking and those who did not.ConclusionsTreatment of single BCCs with ALA-PDT rarely results in unbearable pain. However, the degree of pain can vary depending on the light source used. Further studies are needed to unravel the pathomechanisms underlying the development of pain in PDT in order to develop adequate solutions for this undesirable side effect.