The latest treatments combining CO2 laser and photodynamic therapy to treat basal cell carcinoma, with surgery available where required
Being told you may have skin cancer can understandably feel worrying. Basal cell carcinoma (BCC) is the most common type of skin cancer in the UK, and the reassuring news is that it is usually slow growing and highly treatable, particularly when diagnosed early.
While surgical excision remains the standard treatment for basal cell carcinoma, it can leave significant scars, particularly in cosmetically sensitive areas such as the face, nose, eyelids and ears. At Fairfield Independent Hospital in St Helens, we offer standard surgical excision alongside a newer approach, combining CO2 laser therapy and photodynamic therapy (PDT) to effectively treat BCC with minimal or no visible scarring. Research has demonstrated that this combination can achieve cure rates equivalent to surgery while delivering significantly better cosmetic outcomes. For many patients, the prospect of visible surgical scarring is a real concern.
For patients whose BCCs are suitable for this approach, combined laser-PDT offers the possibility of effective treatment with minimal or no visible scarring. For those whose lesions require surgical excision, our specialists are highly experienced in reconstructive surgery and have a focus not just on the cure but also on the quality of the cosmetic result.
If you have noticed a persistent skin lesion that does not heal, changes in the appearance of a mole or patch of skin, or have received a diagnosis of BCC, specialist assessment can provide clarity and timely treatment.
Basal cell carcinoma is a type of non-melanoma skin cancer that develops from cells in the deepest layer of the epidermis. It is the most common cancer in the UK and is strongly associated with cumulative sun exposure. BCCs most frequently appear on sun-exposed areas of the body, particularly the head, face and neck.
BCCs typically grow slowly and very rarely spread to other parts of the body. However, if left untreated, they can grow larger and invade surrounding tissue, making treatment more complex. There are several subtypes, including superficial, nodular, infiltrative and morphoeic, each with different characteristics that influence the choice of treatment.
Early assessment and treatment of BCC generally leads to better outcomes, both in terms of cure and cosmetic result.
Our specialist Professor Kayvan Shokrollahi is one of the leading proponents of this approach and has published a series of studies on the subject. He explains how this cutting edge approach works:
'During combined laser and PDT treatment, the CO2 laser is first used to precisely debulk the tumour, vaporising the raised or nodular component and creating a clean, bloodless field. A photosensitising cream is then applied to the treated area. This cream is absorbed preferentially by any remaining abnormal cells. When the area is subsequently exposed to a specific wavelength of light, the photosensitiser activates and destroys the targeted cells. The two modalities act synergistically: the laser overcomes PDT's main limitation (its shallow 2mm depth of penetration) by reducing the tumour to a depth that PDT can then effectively treat.'
In Professor Shokrollahi's published study, this combined approach achieved a recurrence-free rate equivalent to surgical excision. The study included not only superficial BCCs but also the nodular subtype, which has traditionally been considered beyond the reach of PDT alone. Patients report significantly better cosmetic outcomes compared with surgery with a less invasive procedure, with many lesions healing with minimal scarring.
Combined CO2 laser and PDT is most appropriate for patients with biopsy-proven BCCs who value excellent cosmetic outcomes and wish to avoid surgery. It is particularly well suited to BCCs in cosmetically sensitive areas such as the face, nose, around the eyes and ears, where surgical excision might require skin grafts or local flaps and leave more noticeable scars. It is not suitable for some subtypes of BCC or certain anatomical locations.
The technique is also especially useful for patients with multiple BCCs who would otherwise face repeated surgical procedures, patients on anticoagulant medication such as warfarin, and immunosuppressed patients (such as organ transplant recipients) who are at higher risk of developing multiple skin cancers.
During your consultation, your specialist will assess your BCC, review the biopsy results and advise whether combined laser-PDT is appropriate for your specific lesion. Not all BCCs are suitable for this approach. Morphoeic (sclerosing) subtypes and deeply invasive lesions may be better managed surgically, and your consultant will be straightforward with you about which approach offers the best balance of cure and cosmetic outcome. Surgery is the only modality that provides a tissue specimen for analysis by a pathologist to confirm removal and margins. All other non-surgical techniques including PDT, radiotherapy and topical treatments cannot provide a lab report and therefore follow-up is required after treatment.
For BCCs that are not suitable for combined laser-PDT, surgical excision remains the gold standard treatment. What distinguishes our approach is that excision is carried out with a particular focus on the cosmetic result, not just tumour clearance.
Standard BCC surgery, particularly on the face, can result in scars from the excision itself or from the reconstruction required to close the wound, which may involve local flaps or skin grafts. Our approach ensures wound closure and scar management are integral to the procedure from the outset, with techniques chosen to minimise the cosmetic impact of surgery.
Following excision, tissue is sent for histological analysis to confirm that the tumour has been completely removed. Your specialist will also advise on post-operative scar management to support the best possible long-term cosmetic result.
The cost of BCC treatment depends on the type, size and location of the lesion, the treatment approach recommended, and whether more than one session or procedure is required. You will receive clear pricing information before making a decision.
BCC treatment may be considered medically necessary rather than purely cosmetic, and some private medical insurers may provide cover depending on your policy and diagnosis. You should confirm this directly with your insurer. For self-funding patients, the team at Fairfield can explain available payment options.
Clear communication ensures you understand the financial aspects of your care before making a decision.
Your consultation begins with a thorough assessment of your BCC, including a review of any existing biopsy results. If a biopsy has not yet been performed, one may be arranged to confirm the diagnosis and establish the histological subtype, as this is essential in determining the most appropriate treatment.
Your consultant will examine the lesion, discuss its location and characteristics, and explain whether combined laser-PDT, surgical excision or another approach is recommended. You will receive a clear, honest explanation of the expected outcome, including realistic information about cure rates, cosmetic results and any risks involved.
If combined laser-PDT is recommended, the procedure can often be carried out as an outpatient appointment. If surgical excision is required, your consultant will explain the planned approach, the type of wound closure and what to expect during recovery.
When you choose to go private with Fairfield Independent Hospital in St Helens, you can expect:
Skin cancer treatment requires accuracy, expertise and careful follow-up. At Fairfield Independent Hospital, your care is delivered by experienced consultant surgeons with expertise in diagnosing and treating non-melanoma skin cancers. Located in St Helens and easily accessible from Liverpool and Manchester, Fairfield provides a professional clinical setting for your treatment.
From assessment through to treatment and aftercare, your journey is structured around safety, clarity and reassurance.
If you are concerned about a persistent skin lesion or have received a diagnosis of basal cell carcinoma, arranging a specialist consultation is the first step.
To book a consultation with a plastic surgeon near you, give us a call and one of our friendly advisors will help you find an appointment time that suits you.
Shokrollahi, Whitaker & Nahai. Flaps: Practical Reconstrctive Surgery. Thieme 2017 (Textbook)
Whitaker IS, Shokrollahi K, James W, Mishra A, Lohana P, Murison MC. Combined CO2 laser with photodynamic therapy for the treatment of nodular basal cell carcinomas. Annals of Plastic Surgery, 2007; 59(5): 484-488.
Shokrollahi K, Marsden NJ, Whitaker IS, Murison WJ, Murison MSC. Basal cell carcinoma treated successfully with combined CO2 laser and photodynamic therapy in a renal transplant patient: a case report. Cases Journal, 2009; 2(1): 7920.
Shokrollahi K, Javed M, Aeuyung K, Ghattaura A, Whitaker IS, O'Leary B, James W, Murison M. Combined carbon dioxide laser with photodynamic therapy for nodular and superficial basal cell carcinoma. Annals of Plastic Surgery, 2014; 73(5): 552-558.
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