# Methyl aminolevulinate

Source: https://onco.cc/drugs/methyl-aminolevulinate/  
OnCo record `methyl-aminolevulinate` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Methyl aminolevulinate is a cream applied to sun-damaged skin or a superficial basal cell carcinoma and then activated with red light, clearing precancerous and early skin cancers with better cosmetic results than surgery or freezing.

## Summary

Methyl aminolevulinate photodynamic therapy has been approved in Europe since 2001 for actinic keratosis, superficial and nodular basal cell carcinoma and Bowen's disease, and in the United States since 2004 (Metvixia) for thin actinic keratoses of the face and scalp. Clearance rates for superficial basal cell carcinoma approach those of surgery in randomised trials with fewer scars, though recurrence over five years is somewhat higher, so guidelines reserve it for low-risk lesions and for patients with many lesions or poor healing. Pain during illumination is the main drawback. Galderma markets it.

## Fields

- Kind: Treatment
- Status: established
- Last checked: 2026-09-08
- Also known as: MAL
- Tags: gap-fill; chembl-universe
- Brand: Metvix / Metvixia
- Modality: Topical photosensitiser cream for photodynamic therapy
- Mechanism: A lipophilic ester of aminolevulinic acid that abnormal keratinocytes convert to protoporphyrin IX; red light three hours later generates singlet oxygen that destroys the lesion.
- Approvals: US 2004: Thin non-hyperkeratotic actinic keratoses of the face and scalp, with red light photodynamic therapy

## Notes

- Photodynamic therapy for superficial basal cell carcinoma, read as a patient would need it. In the Dutch three-arm trial of 601 patients, the proportion tumour-free at both three and twelve months was 72.8 percent after methyl-aminolevulinate photodynamic therapy, 83.4 percent after imiquimod and 80.1 percent after fluorouracil; by five years the probabilities of tumour-free survival were 62.7, 80.5 and 70.0 percent. Moderate to severe pain and a burning sensation during the treatment itself were what patients reported most often.
- The case for it is cosmetic and it is a strong one. Against surgical excision for low-risk nodular and superficial basal cell carcinoma, the Cochrane review found good or excellent cosmetic outcomes at one year in 97.3 percent of patients' own ratings against 82.5 percent for surgery, and 87.1 percent against 46.6 percent on observer ratings, both moderate-certainty. The same review found recurrence of 36.4 percent against 0 percent at three years in a single 68-patient study of nodular disease in the head and neck, which is why it is offered for superficial rather than nodular lesions.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Methyl_aminolevulinate
- Wikipedia: https://en.wikipedia.org/wiki/Methyl_aminolevulinate
- ChEMBL CHEMBL1201306: https://www.ebi.ac.uk/chembl/explore/compound/CHEMBL1201306
- Arits et al., photodynamic therapy versus topical imiquimod versus topical fluorouracil for superficial basal-cell carcinoma, randomised trial of 601 patients (Lancet Oncology 2013): https://doi.org/10.1016/S1470-2045(13)70143-8
- Jansen et al., five-year results of a randomised controlled trial comparing photodynamic therapy, topical imiquimod and topical 5-fluorouracil in superficial basal cell carcinoma (J Invest Dermatol 2018): https://doi.org/10.1016/j.jid.2017.09.033
- Thomson et al., interventions for basal cell carcinoma of the skin: Cochrane review of 52 randomised trials and 6,690 participants (2020): https://doi.org/10.1002/14651858.CD003412.pub3
- Cancer Research UK: photodynamic therapy for non-melanoma skin cancer: https://www.cancerresearchuk.org/about-cancer/skin-cancer/treatment/photodynamic-therapy

## Connected records

- cancers: [Basal cell carcinoma](https://onco.cc/cancers/basal-cell-carcinoma/), [Skin cancer (all types)](https://onco.cc/cancers/skin-cancer/)
- companies: [Galderma](https://onco.cc/companies/galderma/)
- terms: [Creams, light and cold for basal cell carcinoma](https://onco.cc/terms/topical-and-destructive-treatment-bcc/)
- trials: [Photodynamic therapy against cryotherapy for superficial basal cell carcinoma](https://onco.cc/trials/mal-pdt-versus-cryotherapy-superficial-bcc/), [Photodynamic therapy against imiquimod against fluorouracil for superficial basal cell carcinoma](https://onco.cc/trials/mal-pdt-imiquimod-fluorouracil-superficial-bcc/), [Photodynamic therapy against surgery for nodular basal cell carcinoma](https://onco.cc/trials/mal-pdt-versus-surgery-nodular-bcc/), [Safety and Efficacy Study for the Treatment of Non-Aggressive Basal Cell Carcinoma With Photodynamic Therapy](https://onco.cc/trials/nct02144077/)
- technologies: [Photodynamic therapy lasers and light sources](https://onco.cc/technologies/photodynamic-therapy-lasers/)

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