Georgetown Physician Update

Georgetown's New "Blue-Light" Special
Only metro area hospital to offer procedure

A new procedure targeting potentially pre-cancerous cells is now being offered through Georgetown's Dermatology Division. "Blue light," or photodynamic therapy, utilizes a topical, levulinic acid solution and exposure to a bright blue light to combat the rough, raised, red patches of skin that develop following excessive exposure to sunlight. These patches, or actinic keratoses (AKs), can develop into squamous cell carcinoma if left untreated.

"Forty percent of the population over 40 will have an AK," said Lisa Kauff-man, MD, division chief and associate professor, Dermatology. Approximately one-fourth of those affected with AKs will develop squamous cell carcinoma and it is, therefore, imperative "to treat them at their earliest possible stage." This blue-light treatment "selectively
targets sun-damaged cells."

Those most likely to develop AKs are at least 40 years old, fair-skinned and have blue, green or hazel eyes. Prevention at a young age is key, since AKs do not usually appear until 20 years after the sun damage is done. Of those who are affected, one-fourth find their AKs resolve spontaneously and half have AKs that simply grow slowly and remain pre-malignant. It is the remaining one-fourth that most concerns dermatologists, however, for they are those unfortunate few that develop skin cancer.

When patients arrive for treatment, their spots are treated with a colorless liquid called aminolevulinic acid; doctors can treat up to 100 spots during a single procedure. Patients are then sent home, as the liquid takes 14-18 hours to penetrate the skin. They are advised to return to the hospital the following day wearing a scarf or some sort of protective garb that does not expose them to UV rays or harsh light. Patients are then placed under the blue light for approximately 16 minutes. The liquid is washed away at the end of the procedure and the spots eventually crust up and heal in about 7 to 10 days.

The blue light "penetrates deep enough to take care of pre-malignant spots," Dr. Kauffman said. "It's not going to work if the spots are too thick," so early-detection is key.
Photodynamic technology was developed 10 years ago in Europe. "It is not unique to dermatology," Dr. Kauffman said. "It's used in ophthalmology where the light-sensitizing liquid is infused through a vein and is used in urology as well."

Dr. Kauffman learned about blue light in 2000 while reading a journal article. She subsequently trained at Massachu-setts General Hospital, part of Harvard Medical School, to learn how to perform the procedure.

Prior to blue-light technology, patients had two options for combating AKs. "The first option was burning the spots with liquid nitrogen at -170 degrees,"
Dr. Kauffman said. "We were essentially inflicting a controlled second-degree burn. The second option was using a cream on the spots, called Efudex. The only problem with that was that it turned the skin a bright red color and took a month to work."

Blue light has provided patients with a more convenient and less painful option. "Patients love it," Dr. Kauffman said. "As opposed to the cream, you can now accomplish in 18 hours what previously took a month. With liquid nitrogen, you worried about possible skin discoloration, but with blue light it is more likely that the treated skin will heal closer to the original skin pigmentation and you can now treat more spots at once."

Georgetown is currently the only hospital in the DC metropolitan area offering blue-light therapy, with 200 centers nationwide. Dr. Kauffman said the hospital is treating between 5-10 patients a month and the technology is bringing in patients referred from the University of Virginia and Johns Hopkins, as well as from voluntary faculty. Blue light is currently FDA approved for face and scalp, but it is also performed on the arms from the elbow down and the legs from the knees down.

"The bottom line is that people are oblivious to skin cancer," Dr. Kauffman said. "In the 1930s, the lifetime risk for melanoma was 1 in 1,500. Now it is 1 in 42. Twenty percent of Caucasians will get skin cancer in their lifetime. Awareness is essential."

- C. Albanesius