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Introduction
We have been carrying out PDT for 4 years at Falkirk and have had good success with the treatment. Previously treatments were performed at Glasgow Western Infirmary, giving members of the unit 10 years of experience in PDT.
We have treated approx 600 patients in total and at the moment are treating about 175-200 per year. These patients can have varying numbers of lesions- (some single lesions but many of our current patients have multiple lesions).
We accept referrals from out-with Forth Valley, as well as the local population. Patients travelling a distance to our centre appear to enjoy the trip to Central Scotland. Those patients who are fit enough spend the day at the shops or at the areas of historical and modern interest we have on offer (Callander Park, The Falkirk Wheel) until it is time to return for their treatment.
There is currently one Dermatology Consultant in post in Forth Valley (population 275,000). At present in Falkirk (Regional Unit) there are three nurses trained in carrying out Photodynamic Therapy and two currently in training. PDT can become a nurse led service once the appropriate training has been given. This concept is well-advanced at Falkirk. All the nurses at the Dermatology unit, of course, perform the normal mix of duties including dressings and conventional phototherapy.
Our unit organises training sessions for new practitioners on a regular basis – check meetings section of this website for next date.
Careful consideration has to be taken about the numbers of patients we see in a day.
Treatment preparation is short, but illumination times can be long if multiple sites are treated, accurate time-tabling is necessary. If ALA is used rather that Metvix, for ‘off-label’ indications, intervals of 4-6 hours are required, adding to the need for careful planning.
We have had extensive positive feed back from the patients who have attended for PDT. Pain is probably the single side-effect that most concerns patients. We have often been treating large, multiple, often ulcerated sites, often on the scalp/face, all predisposing our patients to experience more pain than if single BCC lesions or a small cluster of AKs are treated in a single session. We have no formal comparison of pain induced by ALA vs. Metvix, with lesion and site-specific issues often conspiring to limit our ability to compare. Now Metvix is approved, we hope to have much more experience soon. Pain should not limit the use of PDT, providing treatment protocols offer the option of analgesia/anaesthesia, if required. Currently, we are finding our patients like our recent acquisition of a Cynosure Smartcool skin cooling package that relieves discomfort.
We have found a high approval rating for PDT from our patients. They usually prefer PDT to previous treatments and are pleased with the appearance of the skin following therapy.
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