Daylight photodynamic therapy (daylight PDT)

Key messages for patients, please read the information in this leaflet carefully

• Please inform us if you have a peanut or soya allergy.
• We are unable to review any other lesions that may be a concern for you on the day. Please discuss other lesions with your consultant at your next clinical review or arrange to speak with your GP.
• Please bring a list of all of your medications and any alert cards about specific medications you take.
• Please take your medications as normal on the day of the treatment procedure, unless you have been specifically told not to take any medication beforehand.

Please call the dermatology nurses on 01223 596245 if you have any questions or concerns about this procedure.

Important things you need to know

Patient choice is an important part of your care. You have the right to change your mind at any time, even after you have given consent and the treatment has started.

The dermatology nurses can only carry out the treatment that has been specified on your consent form. The person undertaking the treatment will have received the relevant training.

All information we hold about you is stored according to the Data Protection Act 1998.

About Daylight photodynamic therapy (PDT) using Metvix® cream

Metvix® (methyl aminolevulinate) cream can be used to treat mild to moderate pre-cancerous skin lesions on the face and scalp known as actinic keratosis. These areas of the skin have been damaged by sunlight and have become rough and crusty. It may mean that you are more likely to get skin cancer in the future unless these areas of actinic keratosis are treated.

Metvix® is a special photosensitising cream used in combination with natural daylight.

We prepare the areas to be treated, apply the cream and then expose those areas to natural day light for two hours.

This is called ‘daylight PDT’ and can only be performed if the outside temperature is suitable (10° or above) usually between March and October in the UK.

The effectiveness is the same on sunny or cloudy day. However, if the weather is rainy or scheduled to rain, daylight PDT cannot be performed and the treatment will need to be rescheduled. We advise that you to check the weather forecast before setting off from home and liaise with the clinic dermatology nurses.

Metvix® cream is absorbed into damaged skin cells only and does not affect the surrounding healthy skin. Exposure to natural daylight for two consecutive hours activates the cream which begins to destroy the damaged cells over several weeks.

The cream cannot be used if you have a peanut or soya allergy or if you have a rare disease called porphyria or if you are diagnosed with a morpheaform basal cell carcinoma.

This treatment is not suitable for individuals with photodermatoses, such as:

• polymorphic light reaction
• xeroderma pigmentosum
• lupus erythematosus
• pemphigus erythematosus

Intended benefits

We have considered other treatment options and there are many factors taken into account. The most important benefits for daylight PDT are:

• significantly less painful when compared with red light activation
• healing is usually quite rapid
• the cosmetic result is usually good
• having this treatment does not prevent you from receiving any of the other
  treatment options in the future

Who will perform my treatment?

The treatment will be performed by a dermatology nurse in clinic 7.

Before your leave to attend the clinic

Please check the weather forecast prior to leaving. If the weather is rainy, or is forecast to rain, daylight PDT treatment cannot be performed and we will need to reschedule your appointment.

Please bring a cap, hat or scarf to cover areas treated on the scalp and face for afterwards. If you have long hair, a hair grip or hair band will be useful to pin your hair back to allow daylight to reach areas that need treating.

Please bring snacks, drinks or your lunch with you. There are also facilities to buy food and drink on site.

After the application of the Metvix® cream, you have 30 minutes to find a place outside, not in direct sunlight and for two continuous hours of daylight exposure.

During your treatment

Please inform the nurse if you have a peanut or soya allergy.

The nurse will apply an appropriate sunscreen as you will be outside and we want to protect unaffected areas of skin from becoming sunburnt. We then remove any crusts from the lesions being treated and/or the skin surface is roughened. A thin layer of Metvix® cream is then applied to the affected areas.

You should then go directly outside after the cream has been applied. We allow up to 30 minutes to get outside. That should give you enough time to visit the bathroom and/or get take away drink/ snacks if you need.

If you live within 30 minutes away (please allow for traffic) you may return home to continue your treatment outside for two hours. You must wash the cream off after two hours. Removing the cream can be done with normal tap water and a towel/wipe. You should then cover the area to protect it from any further natural or artificial light for the rest of the day.

Whether you go home or remain on-site you need to stay outdoors for two continuous hours either sitting or walking around. If you burn easily find a shady place. Please avoid going indoors during this time as it will affect the treatment.

If you remain on site, please return to clinic 7 after two hours. We will help you remove the cream before you travel home. Please factor walking time back to the clinic, as we do not want the cream on your skin any longer than two hours 30 minutes.

It is important to follow these instructions to ensure treatment success.

There are areas within the Trust to sit outside or you can also walk around the grounds if you wish:

After the treatment

Special measures when you return home

Once your treatment has been completed please ensure the treated area is protected from daylight and artificial light for the remainder of the day. Please bring a hat, cap or scarf to cover areas treated on the scalp and face.

After treatment, the treated area may appear red, swollen, weep a little or become crusty. This is a normal response. A simple dressing may be applied if it causes you a problem. It may take 7‑10 days for the skin to settle down. If this occurs, it may help to take over the counter pain medication if not contraindicated.

If the area treated is within the ‘T’ zone of your face (across your forehead and down your nose) you may experience some facial swelling. This is not very common, but can occur and sleeping slightly upright up with an extra pillow can help to reduce this. This is caused by a normal soft tissue response to the chemical reaction that has taken place during your treatment.

You are advised to keep the area dry and covered until the end of the day. You can shower or bath as normal.

A moisturiser may be used to minimise the build-up of scale or crusting.

You may observe a change to the colour of your skin in the treated area. This should settle over time.

Very occasionally the area can become infected. If you are concerned please contact your dermatology nurse to let them know. Alternatively, you may be asked to contact your GP/ practice nurse.

Please continue to protect your skin with sun cream (factor 30 or higher) after your treatment and in the longer term.

Check-ups and results

A follow-up appointment will be arranged 3‑4 months after your treatment. If the skin is clear and there is no sign of any recurrence, you will be discharged back to the care of your GP.

Alternative treatments available

Daylight photodynamic therapy is used to treat certain types of pre-cancerous lesions. There are many factors that need to be taken into account when deciding on the best treatment such as the size, thickness of the lesion and site of the lesion. These factors will have been considered by your doctor or specialist nurse. Other treatments that may also be suitable for treating your skin are:

Surgery – lesions may be removed under a local anaesthetic. This may not always be the best option for larger lesions.

Curette and cautery –involves scraping away the affected area under local anaesthetic. Electrical cautery is used to stop any bleeding. A scar may develop after treatment.

Cryotherapy – the lesion may be suitable for treating with cryotherapy. Liquid nitrogen is sprayed onto the lesion to freeze it. This can feel very cold and a bit uncomfortable.
After the treatment the area will become inflamed and a scab may form.

5-Fluorouracil cream – the cream will need to be applied regularly to the affected area over a period of time, the affected area may become red and inflamed.

Imiquimod cream – the cream will need to be applied to the lesion over a period of time. During the treatment the affected areas may become inflamed.

Significant, unavoidable or frequently occurring risks of this treatment

There are no long-term side effects from daylight PDT therapy but there are some minor drawbacks:

• you may experience discomfort during and after treatment
• a persistent area of discoloration (usually light brown) is occasionally left at the treated area

Common side effects include: scab, swelling, skin feels warm/ hot, pink/ red in colour, skin infection, headache; a persistent area of discoloration (usually light brown); there is a risk that the lesion may recur following photodynamic therapy.

Information and support

If you have any questions, anxieties or experience any problems following your treatment, please call the clinic dermatology nurses on 01223 596245. An answerphone is in place outside of normal office hours so please leave a message and contact number and we will return your call.

Information about important questions on the consent form

1. Photography, audio or visual recordings

As a leading teaching hospital we take great pride in our research and staff training. We ask for your permission to use images and recordings for your diagnosis and treatment, they will form part of your medical record. We also ask for your permission to use these images for audit and in training medical and other healthcare staff and UK medical students; you do not have to agree and if you prefer not to, this will not affect the care and treatment we provide. We will ask for your separate written permission to use any images or recordings in publications or research.

2. Students in training

Training doctors and other health professionals is essential to the NHS. Your treatment may provide an important opportunity for such training, where necessary under the careful supervision of a registered professional. You may, however, prefer not to take part in the formal training of medical and other students without this affecting your care and treatment.