The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on photodynamic therapy for non-melanoma skin tumours (including premalignant and primary non-metastatic skin lesions).
Non-melanoma skin tumours include basal cell carcinoma, squamous cell carcinoma, Bowen's disease and actinic (or solar) keratoses.
Current treatments for basal cell carcinoma include topical chemotherapy, curettage, surgical excision, cryotherapy and radiotherapy. Squamous cell carcinoma is usually removed surgically. Actinic keratoses and Bowen's disease are usually treated with curettage, cryotherapy or topical chemotherapy.
Before photodynamic therapy (PDT), the lesion is prepared by removing overlying crust and scale. Cream containing a photosensitising agent is applied to the lesion and a margin of surrounding skin. The area is covered with a light occlusive dressing and left for a few hours. Excess cream is then removed and the lesion is illuminated by light of an appropriate wavelength to activate the photosensitiser, producing targeted tumour destruction. Occasionally, the photosensitising agent may be given intravenously. More than one lesion may be treated in a session and the treatment may be repeated.
A code from category S07.- Photodynamic therapy of skin below is assigned:
S07.1 Photodynamic therapy of skin of whole body
S07.8 Other specified photodynamic therapy of skin
S07. 9 Unspecified photodynamic therapy of skin
Plus a Chapter ‘Z’ code to identify the body site treated.