Concierge dermatology · London
Photodynamic therapy (PDT) for AK & BCC London.
NICE recommended, non surgical treatment for actinic keratosis, superficial basal cell carcinoma and Bowen's disease. Red light PDT, daylight PDT and Ambulight options across central London dermatology units.
What PDT is
A topical photosensitiser activated by light.
A non surgical, tissue selective treatment for premalignant and early malignant skin lesions.
Photodynamic therapy uses a topical photosensitiser, either 5-aminolaevulinic acid (ALA) or methyl-aminolevulinate (MAL, sold as Metvix), which is applied directly to the lesion and taken up preferentially by dysplastic keratinocytes. The chemical accumulates in abnormal cells over about 3 hours under an occlusive dressing.
The area is then illuminated with a specific wavelength of light, typically 630 nm red light, blue light or, in summer, natural daylight. The photosensitiser is activated and generates reactive oxygen species that destroy the abnormal cells while sparing normal surrounding skin. NICE recommends PDT in technology appraisal TA155 for actinic keratosis, Bowen's disease and superficial basal cell carcinoma.
Indications
When PDT is the right choice.
Confirmed on biopsy or clinical review with dermoscopy by a consultant dermatologist.
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Superficial BCC
Non facial basal cell carcinoma under 2 mm in depth. Preferred sites are trunk and limbs.
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Bowen's disease
Squamous cell carcinoma in situ, particularly on the lower leg where surgery heals poorly.
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Actinic keratosis
Single lesions and field treatment across sun damaged scalp, face, ears and forearms.
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Extensive actinic damage
Organ transplant recipients and heavily sun damaged patients with multiple lesions.
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Nodular BCC (selected)
Less effective than surgery. Used only when surgery is unsuitable or declined.
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Cosmetically sensitive sites
Face, nose and forehead where a surgical scar would be visible.
Procedure options
Red light, daylight or Ambulight.
Three delivery formats. The right one depends on lesion type, site and season.
- 01
In clinic red light PDT
ALA or MAL (Metvix) cream applied and occluded for 3 hours, then illumination for 10 to 15 minutes under a 630 nm red light source.
- 02
Daylight PDT
Cream applied then the patient sits outside in daylight for 2 hours. Available May to September only in the UK.
- 03
Ambulight PDT
A portable, wearable LED device worn at home. Useful for isolated lesions or patients who cannot sit under a lamp.
- 04
Second session
BCC and Bowen's disease typically need two sessions 1 week apart. AK often clears in one session.
- 05
Review at 3 months
Clinical review and dermoscopy at 3 months to confirm clearance and plan any further treatment.
Efficacy
Clearance rates at 12 months.
Best for thin, non pigmented, well defined lesions. Deeper disease needs surgery.
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Actinic keratosis
70 to 90%
Clearance at 12 months across published series for face and scalp AK.
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Superficial BCC
85%
Clearance at 12 months, comparable to surgery for carefully selected lesions.
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Bowen's disease
80 to 88%
Clearance at 12 months, particularly useful on the lower leg.
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Nodular BCC
60 to 70%
Lower clearance rate. Surgery or Mohs is preferred for thicker nodular disease.
Advantages
Why choose PDT over surgery or topicals.
The main reasons dermatologists reach for PDT in the right patient.
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Better cosmesis than surgery
No incision, no stitches and no linear scar. Ideal for the face and other visible sites.
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More effective than topicals for BCC
Higher clearance than 5-FU or imiquimod for superficial basal cell carcinoma.
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Treats field cancerisation
The photosensitiser is taken up across the wider sun damaged field, not just the visible lesion.
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Repeatable
Can be repeated on the same site or nearby areas without cumulative scarring.
Side effects
What to expect and how it is managed.
Predictable, self limiting and well tolerated when the pain protocol is followed.
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Pain during illumination
Moderate to severe stinging or burning. Managed with cooling spray, short breaks and paracetamol or ibuprofen taken before treatment.
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Redness and crusting
Marked erythema, swelling and crusting for 7 to 14 days as the treated skin heals.
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Photosensitivity
The treated area is light sensitive for 24 to 48 hours. Strict sun avoidance and SPF 50 are essential.
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Infection
Uncommon. Occasional bacterial infection managed with topical or oral antibiotics.
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Scarring
Rare. Cosmetic result is usually excellent, especially compared with surgical excision.
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Pigment change
Temporary post inflammatory hyperpigmentation or hypopigmentation, more common in darker skin types.
Cost in London
£280 to £2,800 depending on format.
Indicative self pay pricing. Insurer covered pathways use the same providers.
In short
Red light PDT £850 to £1,600 per session, daylight PDT £280 to £450, full BCC course £1,500 to £2,800.
Superficial BCC and Bowen's disease usually need two sessions one week apart. Actinic keratosis often clears with a single session. Prices include the consultation, cream, illumination and the 3 month review.
Where it is performed
London dermatology units with PDT.
Specialist dermatology centres with red light PDT equipment and consultants who use it routinely.
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The Cranley Clinic
Harley Street. Established PDT service for AK, BCC and Bowen's disease.
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Cadogan Clinic
Sloane Street. Consultant led dermatology with red light PDT and daylight PDT.
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London Dermatology Centre
Wimpole Street. Red light PDT for field AK and superficial BCC.
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HCA The Wellington Hospital
St John's Wood. Dermatology unit with PDT and Mohs on site.
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Chelsea and Westminster Private Dermatology
Fulham Road. NHS grade skin cancer pathway in a private setting.
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The Skin Care Clinic
Central London PDT service with Ambulight portable option.
PDT is also available on the NHS at selected specialist dermatology units with a GP referral, typically with longer waits.
When NOT to use PDT
Where surgery or another route is safer.
Field versus discrete lesion: PDT excels at field cancerisation on the face; single discrete AKs may prefer cryotherapy for speed and cost.
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Nodular BCC over 2 mm deep
Light does not penetrate deeply enough. Surgery or Mohs micrographic surgery is preferred.
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Morphoeic BCC
Infiltrative growth pattern. Requires Mohs to confirm clear margins.
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Invasive SCC
Squamous cell carcinoma with dermal invasion needs excision, not PDT.
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Diagnostic uncertainty
Always biopsy first if the diagnosis is not clear on dermoscopy.
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Porphyria
Cutaneous porphyria and other photosensitive disorders are a contraindication.
Related
Related pathways.
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Mohs micrographic surgery
Definitive surgery for deeper or facial BCC.
Learn more -
Actinic keratosis treatment
Wider AK pathway including cryotherapy and topicals.
Learn more -
Superficial radiotherapy
Non surgical option for selected skin cancers.
Learn more -
Sentinel lymph node biopsy
Staging for melanoma.
Learn more -
Seborrhoeic keratosis removal
Benign lesion removal.
Learn more -
Melasma treatment
Pigment led dermatology.
Learn more -
Mole mapping
Total body photography and dermoscopy.
Learn more
Frequently asked
PDT for AK and BCC, honestly answered.
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Is PDT painful?
The cream itself is not painful, but the illumination phase can sting or burn, particularly on the face and scalp. We use a cooling spray, offer short breaks and recommend paracetamol or ibuprofen an hour before treatment. Daylight PDT is significantly less painful than red light PDT.
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How many sessions of PDT will I need?
Actinic keratosis often clears with a single session. Superficial BCC and Bowen's disease usually need two sessions one week apart. Your consultant reviews clearance at 3 months and may recommend a further round if any lesion persists.
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Does PDT actually cure basal cell carcinoma?
For carefully selected superficial BCC, PDT achieves around 85% clearance at 12 months, comparable to surgery. For nodular or morphoeic BCC, surgical excision or Mohs micrographic surgery is more reliable.
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Is PDT covered by private medical insurance?
Bupa, AXA, Vitality and Aviva usually cover PDT for a biopsy proven skin cancer or premalignant lesion with a specialist referral. Cosmetic use, such as pure field rejuvenation, is not covered.
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How long do I need to avoid sunlight after PDT?
The treated area is highly light sensitive for 24 to 48 hours. Stay indoors or cover the area completely, and apply SPF 50 daily for at least a month while the skin heals.
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What will the treated skin look like afterwards?
Expect marked redness, swelling and crusting for 7 to 14 days, followed by peeling. The final cosmetic result is usually excellent, with no scar and often smoother, more even skin than before.
Speak to a London dermatologist
Book PDT in London, with the right consultant.
We match you to a UK GMC registered consultant dermatologist who runs a PDT service, at a London centre with red light PDT on site. Insurer preauthorisation handled.