LAUSR

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma. Topical photodynamic therapy (PDT) has recently been used in the treatment of early-stage MF, and it may have a promising role as a localized skin-directed treatment option. Laser-assisted drug delivery using ablative fractional CO2 laser (AFL) is a recently described lesion preparation technique used before PDT to improve photosensitizer penetration through vertical channels. Better photosensitizer penetration may enhance the lesion’s response to PDT. To our knowledge, AFLassisted PDT (AFL-PDT) has been described only once previously, which was in a single report published in 2015 in the treatment of pagetoid reticulosis. In this retrospective study, we describe four patients with localized MF (Table 1), treated in our centre by AFL-PDT. The patients were treated between 2012 and 2017. As required in France for decisions on cancer treatment, AFL-PDT was validated at the multidisciplinary team meeting, and the patients were fully informed. We decided beforehand to treat until clearing or for a maximum of 12 sessions. Response to treatment was assessed clinically. Once clinical clearing was obtained, we took a biopsy from three of the four patients to evaluate for histological remission. For each session, we prepared the lesions with AFL (CO2RE laser; Syneron Candela, Wayland, MA, USA). The smallest available fraction was used (fractional coverage 30%; ring size 1; spot size 150 lm). We also used the lowest available energy, which was between 3 and 3.6 J/cm. Methyl aminolevulinate (MAL) cream (Metvix ; Galderma, Lausanne, Switzerland) was then applied, and the lesions were covered with an occlusive light-shielding dressing to enhance cream penetration. After 3 h, the dressing was removed and the cream was washed off. We then irradiated the lesion with red light (Aktilite ; Galderma) at 37 J/cm. The results of the treatments are shown in Table 1. Patient 1 was a 77-year-old man with stage IA MF, localized to the right inguinal area. He received AFLPDT monthly for a total of eight sessions. Three months after the final session, clinical and histological assessment showed complete remission. The duration of remission was 9 months. Patient 2 was a 63-year-old woman diagnosed with stage IA folliculotropic MF localized to the left buttock. She was treated with monthly AFL-PDT for a total of six sessions (Fig. 1). Clinical and histological assessment 6 months after the final session showed complete remission, which was maintained 18 months later. Patient 3 was a 37-year-old woman diagnosed with stage IA folliculotropic MF localized to the left cheek. She was treated with AFL-PDT monthly for a total of four sessions. Two months after the final session, clinical and histological assessment showed complete remission of the lesion, which remained in remission for 6 months. Patient 4 was a 54-year-old man diagnosed with stage IA MF localized to the left thigh. In total, 12 sessions of monthly AFL-PDT were administered. The patient was clinically in complete remission 12 months later. All the patients reported variable degrees of pain and local irritation during the treatment sessions, and postinflammatory hyperpigmentation in the following months. These adverse events were considered mild to moderate by the treating physicians, and no other adverse events were noted. In this case series, patients were treated with monthly AFL-PDT sessions. PDT is a two-step, noninvasive, physical treatment consisting of topical application of a protoporphyrin IX (PpIX) precursor, Correspondence: Dr Motaz Dairi, Department of Dermatology, CHU d’Amiens Nord, Place Victor Pauchet, 80054 Cedex Amiens 1, France E-mail: [email protected]