Photodynamic therapy vs. imiquimod 5% cream as skin cancer preventive strategies in patients with field changes: a randomized intraindividual comparison study

Background Actinic damage is responsible for the development of multiple, recurrent non‐melanoma skin cancers ( NMSC s), including actinic keratoses ( AK s). Photodynamic therapy ( PDT ) and imiquimod cream ( IMIQ ) 5% are recommended as field‐directed treatment options. Objectives To compare efficacy and safety of methyl aminolevulinate ( MAL )‐ PDT vs. IMIQ 5% in the prevention of new NMSC s development patients with field changes. Methods Patients with field cancerization of the face or scalp were randomized to receive MAL ‐ PDT on one side, and IMIQ 5% on the mirror field. The primary endpoint was the number of new lesions on the treated fields during a 12‐month follow‐up period. Secondary assessments included adverse events and patient preference. Results Forty‐four patients completed the study. MAL ‐ PDT and IMIQ did not differ concerning the primary endpoint, as there was no statistically significant difference in terms of development of new NMSC s at any point of follow‐up. Both treatment regimens were safe and well tolerated. Patients' preference based on the procedure, response rates and future choice favoured MAL ‐ PDT . Conclusions MAL ‐ PDT and IMIQ 5% are safe and well‐tolerated treatments that equally prevent development of new AK s in patients suffering from field changes. MAL ‐ PDT treatment appears to be superior in terms of patients' preference.