Red Light Photodynamic Therapy (red light 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 Photodynamic Therapy (PDT)

Photodynamic therapy is a method of treating localised skin cancers called Bowen’s disease (also known as squamous cell carcinoma in situ), superficial basal cell carcinoma and for certain types of pre-cancerous lesions called actinic keratosis (also known as solar keratosis).

The treatment consists of applying a special photosensitising cream called Metvix® cream (methyl aminolevulinate) to the skin lesion and returning to the clinic three hours later. A red light is then shone onto the lesion/s to activate the photosensitising cream. This starts a process in which the damaged skin begins to breakdown over several weeks and subsequent skin healing.

Metvix® cream only affects damaged skin cells and does not affect the surrounding healthy skin.

Bowen’s disease and superficial basal cell carcinomas are treated twice and you will need to return one week later to have the treatment repeated.

Actinic keratosis are treated once. However, if you have a large area to treat you may need to return the following week to treat a different area, given appointment time limitations.

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

The intended benefit will be to treat specific types of skin lesions called Bowen’s disease, superficial basal cell carcinoma and/or actinic keratosis. This treatment does not prevent you from receiving any of the other treatments options in the future.

Who will perform my treatment?

This procedure will be carried out by a dermatology nurse.

Before your procedure – morning application of the cream

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

We will prepare the lesion by cleaning and remove any crust that overlies the area to allow the cream to penetrate into the skin.

After lesion preparation, we apply the special photosensitising cream onto the lesion and to a small area of normal skin surrounding the lesion. This will ensure that we capture damaged cells that are not visible to the naked eye. A dressing is placed over the top to stop natural daylight activating the cream.

It is essential that you do not disturb or press on this dressing in case the cream becomes displaced or squeezed from the treatment area. If the lesion is near to your eye lid, an eye pad can be placed over the eye for comfort.

You will be given a time to return to the clinic, as the cream must be left in place for a minimum of three hours. The cream may be left on for longer than three hours with no adverse effect. Therefore, if you run slightly late on returning to the clinic or the clinic is running behind there is no immediate worry or cause for concern.

Approximately 3 hours later, the dressing and cream is removed and a red LED light is shone onto the lesion for approximately 8-10 minutes. The red LED light is a wavelength within the visible spectrum of light range.

You can stay within the hospital grounds or may leave the hospital site returning after three hours. If you leave the hospital make sure you protect the area from very cold air or direct sunlight. You may eat and drink as normal. Please bring snacks, drinks or your lunch with you. There are also facilities to buy food and drink on site.

Illumination with the red light (THREE hours later)

When you return for the treatment the dressing will be removed and any excess cream. You will then be asked to sit or lie down, whichever is more comfortable.

We will shine a red light LED lamp onto the affected area and give you sun glasses/goggles to wear as the red light is quite bright. The lamp is position 6cm away from your skin.

If the lesion is near to your eyelid, a doctor may need to administer anaesthetic eye drops in your eye and place eye shield, similar to a contact lens, to protect from the bright red light.

The exposure to red light treatment lasts for approximately 8-10 minutes that covers a small treatment area. Depending on how many lesions need to be treated you may need two or three exposures of the red light. For example, a lesion on your front and back of your leg would need two treatment sessions of 8-10 minutes each.

You might experience a tingling or burning feeling during the treatment. Some patients may find this painful. We can pause and restart in short bursts to complete the treatment time.

You may experience/feel that your skin is burning. Reassuringly, the red light does not burn your skin, but it can give some individuals the unpleasant sensation of burning. Not everyone experiences this and to help relieve that discomfort, a cooling water spray can be used. You may also find it helpful to bring over the counter pain relief medication (for example paracetamol or ibuprofen) to take 30 minutes prior to the treatment.

After the treatment has been completed we will apply a dressing to the area.

After the treatment

Please keep the dressing in place for 24-48 hours. This is to protect the skin site and to avoid daylight getting onto the treated area. After this time the dressing can be removed. If you have had an eye patch dressing will be applied, this can be removed after 24 hours. You may also experience swelling around the eye and eyelid that should settle after a few days.

Any discomfort usually settles within the first few hours. Occasionally it will last for up to 24 hours. Taking paracetamol or ibuprofen should help.

After the first 24-48 hours, you can wash, bathe or shower as usual. Do not rub the treated area but gently dab it dry. It is best to avoid swimming until the area is fully healed.

After the dressing has been removed, the treated area will probably crust over. This is normal. Healing takes place under this crust. It is important that you do not disturb or pick and allow the crust to fall off naturally usually after a few weeks.

In some cases, the treated area will appear pink, appear slightly swollen or ooze a little. This is also normal and will usually settle down within a day or so. 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.

To reduce the risk of skin colour changes, for approximately six weeks afterwards keep the area covered from daylight. If the area is on the scalp cover with a hat. If on the face wear a hat to provide shade and apply sun cream once the lesion has healed. If on the body cover with clothing to block out sun light.

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

Photodynamic therapy is used to treat certain types of skin cancers or 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 lesion 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 PDT therapy but there are some minor drawbacks:

• the cream must be applied at least three hours before we give you the red light treatment
• you may experience pain and discomfort during and after the red light treatment.

Common side effects include: skin burning sensation, 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 dermatology nurses on 01223 596245. An answerphone is in place outside of normal office hours so please leave a message and contact number.

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.