Topical photodynamic therapy with 5-aminolevulinate for the treatment of tumor-stage mycosis fungoides: a case report.

A 70-year-old male patient with generalized tumor-stage mycosis fungoides (MF) presented to our office. He had been treated with psoralen + ultraviolet A, bexarotene, and total-skin electron beam radiation with poor response. He rejected systemic chemotherapy. The most uncomfortable lesions were those involving his face, fingers, buttocks, and calcaneus region (Fig. 1a). Skin biopsy confirmed the diagnosis (Fig. 2a). We offered him topical photodynamic therapy (PDT) with methyl-aminolevulinate (MAL). A 1-mm thick layer of 160 mg/g MAL cream (Metvix ; Photocure ASA, Oslo, Norway) with a 5 mm of margin was applied and covered with an occlusive dressing (Tegaderm ; 3M Health Care, St. Paul, MN, USA) for three hours on his fingers and buttocks, and in the calcaneus region. MAL was then cleaned with physiologic solution 0.9%. Irradiation was done with red light using a Waldmann lamp (PDT 1200 L, incoherent light source lamp) with a wavelength of 570–670 nm, 37 J/cm, and 70 mW/cm. Two to three sessions were done, depending on the lesion, each one separated by two weeks. Complete clinical and histological remission was achieved after treatment (Figs. 1b and 2b). No recurrences after five years of follow-up have been observed in the treated areas. New lesions have appeared in non-treated areas with excellent response to conventional therapies.