Using photodynamic therapy in conjunction with the intralesional instillation of δ-aminolevulinic acid, as reported by Fink-Puches and colleagues,1 was certainly a novel and ultimately successful solution to the therapeutic challenge posed by a patient with a large superficial basal cell carcinoma who refused surgical intervention. What I found surprising, though, was that this case was felt to be particularly challenging since radiation therapy was an obvious nonsurgical alternative therapeutic option. As noted by Goldschmidt et al2 in their recent comprehensive review of the use of ionizing radiation in dermatology, radiation therapy is an effective treatment for epithelial skin cancers, particularly for lesions measuring less than 5 cm in diameter. I believe that it is important to realize that although the treatment reported by Fink-Puches and colleagues may have been of interest because of its novelty and ultimate success, radiation therapy remains the established nonsurgical modality for the treatment of superficial basal cell skin carcinoma.
Sherr DL. Therapeutic Options for Superficial Basal Cell Carcinoma: The Role of Radiation Therapy. Arch Dermatol. 1998;134(6):752. doi: