Photodynamic Therapy (Metvix)

Following a consultation with your dermatologist he may recommend Metvix-PDT treatment as being suitable for you.

Metvix-PDT is used as an alternative to surgery for the treatment of Actinic Keratoses (AK) and certain types of Basal cell carcinomas (BCC) on the face and scalp.

Metvix is a cream that contains methyl aminolevulinate. This substance is specifically absorbed into the altered skin cells of these lesions. Metvix causes compounds called porphyrins to accumulate and be absorbed selectively by the AK and BCC lesions. These porphyrins are light sensitive, so when the Metvix is illuminated and activated by an appropriate light source it causes a chemical reaction in the skin cells that destroys the lesion.

Metvix-PDT requires two treatment sessions, 7 days apart, to ensure the lesion is adequately destroyed.

Before commencing treatment you must ensure you are available for both sessions.

Precautions and contraindications

• Metvix contains peanut oil. Peanuts are a known allergy.
• Metvix may cause sensitisation of skin on contact and rarely may cause local skin reactions such as contact dermatitis.
• Any UV therapy should be discontinued before treatment.
• As a general precaution avoid sun exposure on the treated area for a couple of days following treatment.
• There is no data on Metvix and exposed pregnancies and reproductive toxicity studies have not been performed on animals so Metvix is not recommended during pregnancy.
• In the absence of clinical experience breastfeeding should be discontinued for 48 hours after application of Metvix cream.
• Treatment will not be performed if you are sunburnt or have significantly tanned skin (this includes fake tan applications).
• Let your Nurse know if you have a history of cold sores as Metvix-PDT treatments can trigger herpes simplex activation. You may be prescribed an anti-viral medication for prevention of cold sores.

Treatment Procedure

• Day of treatment:

Having already seen your dermatologist you will now need to see the PDT nurse to go over expectations of treatment and ensure you understand everything about the procedure before signing consent forms.

1. A 15 minute appointment will be booked for you to have the Metvix applied to the lesions to be treated, which will then be covered with a flesh coloured dressing.

2. There is a 3 hour waiting period for the Metvix cream to be absorbed. You can leave the surgery during this time but you must leave the protective dressings intact.

3. When you return to the surgery the Metvix will be washed off and immediately illuminated with a red light, the intensity and time exposed to red light depends on the type of lesion we are treating. Light exposure can be anywhere between 8-20 minutes.

• Follow-up appointments:

7 days after first treatment you will need to have your second treatment.

You will then be required to attend the clinic for follow up appointments with the PDT nurse 7 days after your second treatment.

1 month after your second treatment you will need to see the PDT nurse for a follow up.

You are then expected to see your consulting Dermatologist 3 months later for a skin check to assess cure of the treated lesions and detect any new lesions.

As you are prone to these pre-cancerous and cancerous lesions from past sun exposure it is recommended you have ongoing skin checks with your dermatologist or GP for detection and treatment of any new lesions.

Side effects

Expected side effects:

• There is an element of pain during treatment
• Burning and stinging sensation at time of light activation
• Crusting of lesions treated
• Swelling and redness at treatment site that can last up to a week or two.

Common side effects:

• Ulceration of lesion treated
• Blistering
• Erosion
• Peeling
• Hyper or hypo pigmentation ( a darkening or lightening of the skin at area treated)

Pain Management

• Most people tolerate treatment with a mild discomfort level being reported.
• A Mild pain killer is advised to take the edge off any anxiety and reduce the level of pain you may feel. Try not to have any stimulant drinks at least 2 hours before treatment such as coffee, tea, V or Red Bull as these heighten anxiety and can intensify the pain you may feel.
• It is advisable that you take 2x Panadol or Panadeine tablets 1 hour before your Illumination appointment. If stinging and burning is experienced following treatment continue to take Panadol every 4-6 hours and ice with ice packs provided.
• A fan may be used during treatment by your nurse to cool the skin if you start feeling pain or discomfort during treatment.
• If the pain you experience during treatment is unbearable then treatment can be ceased and a local anaesthetic injected into the lesion to numb it. As most people don't unnecessarily want injections this is only done if necessary.

Appointment Schedule

Initial assessment: initial consult is with your Dermatologist for assessment. If Metvix PDT indicated then to see PDT nurse.

On day of treatment:

A 15 minute appointment is booked with a Nurse for application of Metvix – this needs to be 3 hours before illumination treatment.

A 30 minute appointment for illumination treatment is made 3 hours after Metvix application, to activate it.

7 days after first treatment: appointment should have been pre-booked at time of first appointment for another Metvix PDT treatment session as above

7 days after second treatment: A 15 minute PDT follow up appointment with PDT nurse.

1 month after second treatment: A 15 minute appointment with PDT nurse for follow up and discuss maintenance skin care.

3 months after second treatment: consultation with Dermatologist to assess cure of lesions.

Please ensure you completely understand the procedure, expected outcomes, have had all your questions answered to your satisfaction and have read and understood the After Care sheet before signing the consent form.

After Care

• Leave treated area uncovered.
• Clean as normal in shower, using the mild cetaphil face wash provided.
• You will have been given a prescription to take to the chemist and get a tube of fucidin ointment.
• Treated lesions are to be kept moist with Fucidin applied 3x a day for 7 days to encourage re-epithelialisation
• If in an area where clothing will irritate then cover with micropore tape and apply fucidin over the top of tape which will soak in.
• Make sure all your follow up appointments are booked
• Following Metvix PDT, you may experience a burning or stinging sensation and some degree of pain. These reactions are generally transient and of mild to moderate intensity. swelling and erythema may also occur and a crust may form over treated lesion
• If there is excessive swelling and redness post operatively the patient will need to see their dermatologist for consideration of systemic anti-inflammatories etc.
• If pain continues post treatment Panadol or Panadeine is recommend every 4-6 hours and cooling with ice packs.
• Your skin will be sensitive and a bit fragile following treatment so as a precaution avoid direct sunlight for a couple of days after treatment.
• Sunscreen needs to be applied everyday even in Winter and if the sun is not out.
• Make sure you use a broad spectrum 30+ sunscreen specific for use on the face. If you are unsure about the product you are currently using or want advice on sunscreen, your nurse can discuss and recommend a sunscreen product suitable for your skin type.

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