Is Photodynamic Therapy the Best Option for Elderly Patients with Skin Lesions?

A black mole on the face, about the size of half a thumb, is suitable for treatment with photodynamic therapy?

Director Hong: I would like to ask about an elderly woman over 95 years old who has developed two black moles (melanomas) on her face: 1.
one under the lower eyelid of one eye, and 2.
one on one side of the nasal bridge, each approximately the size of half a typical person's thumb.
1.
The first mole seems to have stopped "growing," and the outer black skin is starting to fall off.
2.
The second mole appears to still be "growing," and when touched, it bleeds a very small amount.
My question is: Is "photodynamic therapy" the least harmful and most effective treatment option for this elderly woman, potentially curing (or at least significantly treating) the majority of the condition? Thank you!

sspp, 40~49 year old female. Ask Date: 2008/01/26

Dr. Hong Zhengsheng reply Dermatology

Hello, all laser treatments or photodynamic therapies for cosmetic purposes to remove spots should only be recommended after excluding any malignant skin changes.
If you need to use the aforementioned therapies, it is also advisable to rule out any systemic metastasis.
I apologize, but based on your description, I cannot ascertain your specific condition.
The best advice is to consult a dermatologist you trust.
I recommend that when you notice the symptoms described, you should promptly visit a public hospital in your city or county and consult with a dermatology specialist.
All the physicians at our department are very willing to assist you.
Thank you for using "Taiwan e-Hospital" to ask your question.
"Taiwan e-Hospital" cares about your health.

Reply Date: 2008/01/26

More Info

Photodynamic Therapy (PDT) is a treatment that utilizes light-sensitive compounds and light exposure to target and destroy abnormal cells, making it a potential option for various skin lesions, including certain types of skin cancers. However, when considering its application for elderly patients, particularly those over 95 years old, several factors must be taken into account, including the nature of the skin lesions, the patient's overall health, and the potential risks and benefits of the treatment.

In the case presented, the elderly woman has two skin lesions described as black moles, one of which appears to have stopped growing while the other seems to be actively growing and even bleeding slightly. The first step in evaluating the appropriateness of PDT is to ensure that these lesions are benign or, if malignant, that they are suitable for this type of treatment. It is crucial to conduct a thorough dermatological examination, possibly including a biopsy, to determine the exact nature of the lesions. If the lesions are indeed malignant, PDT may not be the most effective treatment option, especially if there is a risk of metastasis or if the lesions are aggressive.

PDT is generally considered less invasive than surgical options, which can be beneficial for elderly patients who may have comorbidities or a higher risk of complications from surgery. However, it is not without its risks. Common side effects of PDT include localized pain, swelling, redness, and crusting at the treatment site. In elderly patients, the skin may be more sensitive, and the healing process can be slower, leading to prolonged discomfort or complications.

Moreover, the effectiveness of PDT can vary depending on the type of skin lesion being treated. While it has shown promise in treating superficial basal cell carcinoma and actinic keratosis, its efficacy in treating more aggressive forms of skin cancer may be limited. Therefore, it is essential to weigh the potential benefits of PDT against the risks, especially in an elderly patient with potentially fragile health.

In conclusion, while Photodynamic Therapy may offer a less invasive treatment option for certain skin lesions, it is not universally the best choice for all elderly patients. A comprehensive evaluation by a qualified dermatologist is essential to determine the most appropriate treatment plan. This evaluation should include a thorough assessment of the lesions, consideration of the patient's overall health status, and a discussion of the potential risks and benefits of PDT compared to other treatment options. Ultimately, the goal should be to provide the safest and most effective care tailored to the individual patient's needs.

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