ALA-PDT: the treatment of non melanoma skin cancer re-illuminated

Non melanoma skin cancer (NMSC) is the most common cancer in Caucasian people (1,2). NMSC mainly consists of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Often Bowens disease (SCC in situ) and actinic keratosis are considered to be included although they are not invasive. It is an important and a growing healthcare problem. If current trends continue it is expected that there will be 80% more (new) skin cancer patients by 2015 compared to those in 2000. The number of BCC patients will increase by 78% and by 2015 there will be 26000 new cases of fi rst/primary BCC compared to 15000 in 2000 in the Netherlands. The largest increase in incidence is expected to be in younger age groups 15-64 years (females 94%, males 66%), and due to an increase in superfi cial BCC (3,4). A typical BCC patient is female, becoming younger, and presenting with a superfi cial lesion. If current patterns of sun exposure do not change this increase in incidence will continue over time due to the ageing population (3,5). A serious rise in annual demand for care for non melanoma skin cancer will occur. Although NMSC is the most common cancer, death from NMSC is uncommon but it occurs. An estimated number of 1017 deaths due to squamous cell carcinoma (SCC) and 672 due to BCC in man and woman of all ages occurs yearly in Europe (6). In 20 % of the deaths due to skin cancer metastases of SCC are the cause of death(7).

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