Fractionated Ablative Laser-Assisted Methyl Aminolevulinate Photodynamic Therapy with 532-nm KTP Activation for Multiple Basal Cell Carcinomas in Gorlin Syndrome: A Case Report

Vollständiger Abstract

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Basal cell carcinomas (BCCs) in Gorlin syndrome are often numerous, recurrent, and difficult to manage with repeated surgery because cumulative procedures may produce substantial morbidity, scarring, and disfigurement. Methyl aminolevulinate photodynamic therapy (MAL-PDT) is an established tissue-sparing option for superficial BCC and selected thin nodular BCCs, with favourable cosmetic outcomes and the ability to treat multiple lesions during a single session. Unfortunately, conventional photodynamic therapy (PDT) is limited by inadequate photosensitizer penetration into thicker tumours and by treatment-related pain during illumination time. This report describes a novel laser-assisted PDT protocol for multiple BCCs in Gorlin syndrome that combines fractionated ablative laser pretreatment to enhance intralesional penetration of methyl aminolevulinate (MAL), followed by a 3-hour incubation and photoactivation with a 532-nm KTP vascular laser rather than conventional blue or red light. The conceptual novelty of this approach is twofold: first, ablative fractional laser creates vertical channels that markedly increase delivery of topical photosensitizer into deeper tissue; second, the activating vascular laser may plausibly provide dual benefit by both activating accumulated protoporphyrin IX (PpIX) and exerting direct vascular-directed effects that have independently shown efficacy against BCCs, all while potentially reducing treatment-related pain. Following treatment, the patient achieved excellent lesion-level clearance with no scarring or dyspigmentation, no reported pain, and 94% (51/54) lesion-level clearance at 12 months. These findings suggest that fractional ablative laser-assisted MAL delivery combined with KTP-mediated activation may represent a promising office-based, scar-sparing strategy for selected patients with multiple BCCs, especially when repeat surgery is undesirable.