Skin cancer: my experience with photodynamic therapy (PDT)

Skin cancer: my experience with photodynamic therapy (PDT)

Nikki Parkinson Health, Life 29 Comments

As a pale-skinned Aussie kid who grew up in the 1970s not wearing shoes to school, let alone hats or sunscreen, I’ve done extremely well to get to almost 53 before having my first skin cancer treatment: photodynamic therapy (PDT).

At my annual skin check this year, I asked my doctor about the small area of flakey skin on the bottom right of my lip line. It would come and go but never stay away. She told me it was skin cancer – solar keratoses – and there were more on the bottom left of my lip line. More I couldn’t even see or feel. (Below is just before I went in for the treatment)


Before Photodynamic Therapy (PDT)

Because I’m vain (and frequently have to schedule my working week around photoshoots), my first questions were about down times from treatment options. See above: VAIN.

My doctor said that this area would be a good candidate for photodynamic therapy and that downtime would be about a week. This was significantly less than the alternatives of laser therapy (weeks) or surgery (months)

I went away from that appointment madly Googling for any real-life experiences and photos from the treatment. To be honest, there wasn’t much, which is why I’ve chosen to write about my experience here. (👋 if you’ve stumbled across this post via a Google search)

Before I get into the nitty gritty and some very non-pretty lip photos (consider yourself warned), I want to reiterate a skincare message that I’ve been shouting to the rooftops for as long as I’ve had a platform to do so:

Wear sunscreen. EVERY DAY.

The only reason I’ve not needed treatment before this year is because my mum was ahead of the times and slathered us in sunscreen when it was far from the trend of the day. This was the era of baby oil, tin-foil sun-baking and tan lines worn as badges of honour.

That early sunscreen habit stuck and continues to this day and my skin is thankful for it. Yes, I’ve stuck to a daily skincare routine since I was 18 but without sunscreen being the front and centre of that routine, I would not have the skin texture and colour I do today.


Skin cancer: my experience with photodynamic therapy (PDT)

Photodynamic therapy: how it works

A light-activated cream (Metvix) is applied to the affected area (anywhere on the face or scalp). Over a period of two-three hours, this creates a reaction in the cancerous cells to produce a chemical that, when activated with light, selectively destroys those cells but leaves the healthy ones alone.

1. Metvix applied.

Metvix applied photodynamic therapy (PDT)

2. Affected area is covered in plastic and tape.

Affected area covered in tape Photo Dynamic Therapy

3. I can no longer talk. Some in my household would be happy about that but I’m in the surgery, socially isolated for two-three hours with my laptop. I can’t annoy anyone with my words. I’ve stuffed my mouth with tissues in the hope that I don’t drool too much. I do.

Waiting 2-3 hours for the Metvix to do its thing

4. My doctor applies a dental block to my lips. It’s ouchy and causes an adrenalin surge in my body. I’m shaky and my heart is racing. Not fun at all.

5. It calms down and the light exposure starts. I’m under for seven minutes. As someone who loves a monthly LED treatment as part of her facial, I can tell you this is NOT the same and far from relaxing. Even with the dental block, it feels searing around the lips, like burning.

Dental block in: Photo Dynamic Therapy

6. I sit up, try to drink from a straw (spoiler alert: it’s not possible with a dental block)

7. After about 20 minutes, I’m off home with my post-treatment care instructions and the beginning of my  obsessive daily looking in the mirror to see if it’s healing.

Photodynamic therapy: after-care

Imagine the worst combination of sun and windburn, with a dose of fresh chilli on top and you’ll come close to understanding just how much my lips hurt in those early days.

It’s essential to cleanse (with a moisturiser like Cetaphil or QV) and moisturise the area three times a day but because it’s the lips, I found I did this more often, especially after eating. 

And my tube of Lanolips Golden Dry Skin All Over Salve was never out of my sight. I slathered this on my lips throughout the day and layered it up overnight. This is my favourite product for putting on my lips before bed every night and it worked brilliantly during the 10 days post-treatment. 

You need to keep makeup away from the affected area until its healed and it’s essential to keep out of the sun during that time as well. Don’t exfoliate or use products with acids or active ingredients until two weeks afterwards.

Now that it’s healed, I make sure I apply an SPF 50 lip balm when heading outside. I’ve been very impressed with Ultra Violette Sheen Screen SPF 50 Hydrating lip balm (you can’t go wrong with any of the shades!).

Photodynamic therapy: the diary

Day 1-9 Photodynamic Therapy (PDT) on lip cancer

Day 1: When dental block wore off, it felt tingly, like chilli sitting on my lips. I cooled my lips on the side of a very cold wine glass. It was Friday. 🤷‍♀️

Day 2: Woke up with crusty, dry lips and that feeling when you’ve got really bad sun or wind burn. Made a really bad decision about drinking a margarita that afternoon. Ouch. But tasty. Introduce a glass straw as a work-around. Everything really is figureoutable. 

Day 3: That burning feeling was dialled up with a side offering of blistering and puss. SO attractive. 

Day 4: Skin started coming off and there was more blistering. The area wasn’t as painful as long as I kept it moisturised and away from acidic food. 

Day 5: There was less skin flaking. A line of small, clear blisters appeared along the bottom lip line. I did a photoshoot for a client, avoiding any close-ups, utilising hair flicks to hide my lips. Dinner fail: Asian lime dressing was not a good idea. 🤦‍♀️

Day 6: You’d think I’d have learned by now but I made the mistake of including tomatoes on my sandwich – big mistake. The swelling was down but the lips was stingy and sensitive.

Day 7: The swelling and blisters had disappeared. I woke up for first time not feeling pain or dryness.

Day 8: There is further improvement but the lips were still a little tender and there was still some stinging.

Day 9: The lips still got very easily but redness was just on site of the cancerous cells.

One month: I got the all-clear from my doctor. She was happy with how the treatment had worked but will follow up again in three months’ time.

1 month post PDT for lip cancer

Photodynamic therapy: the verdict

This isn’t a treatment that’s covered by Medicare in Australia, which is disappointing, but for me it was an ideal choice to address a problem before it got worse, with as little down time as possible.

It cost me $250. The cost depends on the area to be treated and can range up to $700. You may require more than one treatment to achieve the desired result. 

I highly recommend this non-surgical treatment if advised by your doctor or specialist. The short down-time and minimal discomfort was worth it.

So, tell me, is this a treatment you’ve undergone? What were the results? When was the last time you had a skin check?

Please note: I’m not a medical professional. The above experience was just that – my experience. Talk to your GP or skin specialist for advice specific to your skin. If you’d like to know details of my doctor, who does my annual skin checks and who carried out this treatment, please email [email protected]

Comments 29

  1. I had my PDT done yesterday, full face and both hands. My hands are fine but my face is on fire and I’m desperately searching for information regarding how long until this pain subsides!!! I’m happy to share some photos for others, so little information out there regarding this treatment!! Thank you for your article

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  2. This website is a godsend. There is not much information post PDT. Like everyone I was proud of having the brownest belly from sun baking in baby oil during the 80’s. I’m on day 5 of having nose and cheeks done and the pain is excruciating. The itching is not fun either. Crust on or off? Very confusing information out there. Now I know that others have gone through this and it is worth it. Thanks!

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      So glad you found this post Karen … that’s why I wrote it. I couldn’t find anything when I was searching before my treatment. Hope you come through the other end feeling fabulous and skin cancer free.

  3. I’ve been getting PDT treatment for over 20 years. I was one of my dermatologist’s first patients in the very early days of this treatment. It has saved my face. I did need to have one aggressive BCC cut out of my face where PDT would not have worked. However I’ve had 6 more cancerous lesions on my face which PDT therapy has cleared up. From my experience patients definitely require more than one treatment (over years) depending on the level of damage of course. I’m also fair with Irish & Scottish descent and grew up in the 1960’s & 70’s in Queensland. For me the treatment is continual work in progress but it definitely works. I’ve also had part of my chest done but not as often as my face. Many more have been cut out of my legs & arms etc but that’s another story. I agree, I see young photos of myself when I was as brown as a berry and now I cringe when looking at these photos. How we ruined our skin in those days because we thought it looked attractive.

  4. I just had my whole face done with the Metvix. I had to also go outside and sit in the sun to activate the cream. It hasn’t been too bad. Just like really bad sunburn. Hopefully it works! The doctor wanted me to do the effudix but I chose PDT because the effudix side effects sounded brutal. Thanks Nikki and everyone else for sharing.

  5. I’m 6 and a half weeks past the initial treatment. The area of concern is still inverted, flat and peeling. Does this sound normal?

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    2. I had my whole face done 16 days ago
      The first 9 days I’d say were brutal
      I couldn’t leave the house – it was painful and very ugly
      However my skin now that it’s recovered ( I didn’t think it ever would) is improved
      It’s smooth and less red

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  6. I am into day four after having the PDT procedure done on my face, neck and chest and are off for a checkup this afternoon. I found it to be quite intense under the lights then after coming home l unfortunately ended up in emergency as l had a very big drop in blood pressure (diagnosis Hypersensitivity- who would have thought!) All peeling now and looking a bit hideous but if it means no more skin cancer then it’s a job well done. With only baby/coconut oil used when young, SPF 50 is now the way to go ~ and just think how young I’m going to look when I’m all healed!

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  7. I think it is useful to differentiate between blue light and red light therapy. The red is far more penetrative to my knowledge. I had the red light a few years ago without anaesthetic and it was quite painful but I only needed one treatment. I recently had two more areas treated simultaneously , close to my eye and also just above my lip. They were bigger cancers and required 2 red light treatments 2 weeks apart and I opted for local anaesthetics. The one near my lip was very painful but I didn’t feel a thing during the treatment and recovery was a breeze both times. I agree, that bandage near the lip is quite tricky to keep dry. As well as avoiding the sun, you are not supposed to go out into the daylight for 48 hours as the drug will re activate and you effectively start a milder treatment on top of the original apparently.

  8. Can I ask who you see for your skin checks. I feel this is a priority area but can’t seem to find the right fit.

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  9. I found your site searching for a photo diary of pdt as I’m currently in research mode. Thank you! Your page is very informative 🙂
    My doctor has recommended I use effudex next winter and I really never ever want to use that product again! I had quite a lot of reactions to effudex (pain, couldn’t sleep, headache/migraine, metallic taste in mouth, upset tummy, depression/crying – and I’m not really like that) – plus the result of my skin looking really dreadful for ages. I really copped it!
    I think (maybe) that pdt might be for me.
    I’ve had a SCC removed from my temple six years back (mostly unnoticeable flap scar 26 stitches), BCCs from nostril (neat graft) & neck (6 stitches ugly scar) last year, and now am on a wait list for another BCC on my other nostril (another graft probably).
    I’m paying the price of being a child of the seventies too, with red hair, green eyes and fair skin. Really, I’ve probably gotten off lightly to date.
    Thanks again. I hope your site helps other people – it has helped me 🙂 Yvette

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  10. That treatment looks incredibly painful Nikki but so glad it’s done and the results are fantastic.
    I am paying for my teenage years spent laying in the hot backyard and going to Cronulla beach on the weekends with baby oil slathered on my skin.I had a squamous cell carcinoma removed from my face last year,luckily the Dr removed it all first go but I had 4 stitches in my face.The scar is tiny only I notice it.I also had some other skin cancers taken off my hands and legs Only basal cell ,but I was told my ancestry has a lot to do with getting them,Irish and Welsh great grandfathers on my Dads side and Scottish on my Mums.
    It’s funny how we’ve changed our thinking about the sun and tanning Pioer was looking at really old photos of me last week and she told me your skins looks yuck Nanna it’s brown and it was really brown.

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  11. I’ve just turned 62 and have nothing on my skin that needs attention. My dad is about to turn 92 and despite a life of sun and surf the same.
    But this treatment looks like a godsend. Efudix is a ridiculous process and surgical removal means they take a huge chunk. How might lips ever recover.

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  12. I had my whole face and both lips done last year. PDT treatment was a little different to yours they put the cream on in the surgery and then I had to go outside and walk in the sun for an hour with no hat on which didn’t feel right and did I burn baby burn then the cream was taken off and I could go home. My lips got infected day 4 and it was so painful I was also under a lot of stress at the time which didn’t help. No pain no gain. Now my skin looks ah-mazing and I’m so glad I did it, I agree with your advice wear Sunscreen!

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  13. Yes I have had my whole face done too!! I didn’t quite realise how much the light would stir it up. On the 2nd day I had a drs appt so drove there in my car. The pain was excruciating!! I had a hat to protect me from the sun but that didn’t help. Applied ice packs when I got home. Great result but next time I will know not to step outside the door for 3 /4 days.

    1. Oh yes… 3/4 days indoors is a must.
      Such an effective treatment.
      I did tell my specialist that he had better have got the job done, because I was never doing it again. !!!
      The 6/8 hours directly after treatment was awful.
      Wishing you never need it again also.xx

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  14. Yes…
    I had my whole done on the 4th July last year… I had previously used the efudix cream on my nose to clear up some little spots, and that was successful. However, the 6/8 week time frame for that product seemed a little overwhelming when my skin guy informed me it would be best to do my whole face…soon.!!!!
    It was about 10 days from treatment to a ‘back to normal’ face… still a little pink for a while, but the dryness, flakiness cleared in that time…
    It was horrific but I can honestly say I am very pleased with the results.
    I’d love to share my photos but I don’t think that’s possible here…
    Sunscreen everyday, even on a dull day is not negotiable now.

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