We appreciate the interest of Sherr in our article on photodynamic therapy (PDT) of superficial basal cell carcinoma by instillation of δ-aminolevulinic acid (ALA) and irradiation with visible light.1 We agree with him that the use of ionizing radiation therapy is an effective treatment for epithelial skin cancers. However, it is well recognized that ionizing radiation therapy can sometimes lead to chronic radiodermatitis, which tends to worsen in its appearance over time.2 In contrast, the short- and long-term cosmetic results after ALA-PDT always seem to be excellent.3-5 Whereas the long-term recurrence rate with topical ALA-PDT after epicutaneous drug application is under current investigation,4 this rate is completely unknown for ALA-PDT after intralesional drug instillation. However, for ionizing radiation therapy of basal cell carcinoma, the recurrence rate may be considerably higher than that generally assumed by dermatologists. After a 10-year follow-up, it seems to be realistic to count on a recurrence rate of at least 10% to 12%.6
Fink-Puches R, Wolf P, Kerl H. Therapeutic Options for Superficial Basal Cell Carcinoma: The Role of Radiation Therapy—Reply. Arch Dermatol. 1998;134(6):752. doi:
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