Levulan and Metvixia: The Tomato Treatment

I had another tomato treatment today, and it wasn’t any more fun than the last four.  Dermatologists or their proxies do this to their patients, but Jack Bauer and the CIA should give it serious consideration.  It could obsolete water boarding.  Getting a tomato treatment is pretty simple and requires no water.  The doctor decides which part of your body wants to become a tomato, and then he leaves for golf.  In my case, he thought my scalp, from my forehead to my nape, wanted to become a tomato.  He came to this conclusion because my scalp was peppered with little rough bumps.  These little bumps are called actinic keratoses, which are mildly annoying, but which can evolve into squamous cell cancer, which is a lot more annoying.  Turning your head into a tomato is pretty annoying, too, not to mention painful.   On the other hand, I had a small squamous cell cancer removed from my neck once.  Before the doctor called it a day, she had subjected me to four consecutive Mohs surgeries and let me look at the large open hole before she sewed it up.  The four surgeries were easier than looking at the hole and wondering how she could possibly close it.  The thought of having a hundred of these holes in my scalp was what motivated me to take the tomato treatment.

After the dermatologist left for golf, one of his distractingly attractive assistants entered the treatment room.  She pulled a metal tool that looked like a miniature garden hoe out of a scabbard, and began scraping my scalp as if she were clearing weeds in caliche.  I winced now and then, but repeated only my name, rank and serial number.   She furrowed her brow and looked around the room.  Her eyes settled on a bottle of acetone, and I broke out in a cold sweat.  Surely she wouldn’t be thinking of putting acetone on a newly-scraped scalp?  But she was, and she did, rubbing it in with vigor and a pot-scrubber.  I was ready to tell her everything, but I couldn’t speak.  She smiled, re-corked the acetone and picked up a jar of chemical paste labeled Metvixia.  She glanced at the hoe, but chose a tongue depressor instead, and began applying the mixture to my raw scalp like a bricklayer.  Next, she found a dispenser of Saran wrap.  She peeled off three feet of the clear plastic and wrapped the top of my head, from forehead to crown.  Eyes watering and still speechless, I was hoping she would cover my nose and mouth, too.

So what is this stuff?  Metvixia (methyl aminolevulinate) is selectively absorbed into actinic keratosis or cancer cells where it is converted into porphyrins, photoactive compounds that are sensitive to light.  After an absorption time of three hours, the patient is exposed to a specific wavelength of red light for about six minutes, during which time the porphyrin-loaded cells are destroyed in a molecular reaction.  The process can be uncomfortable at best or burning and painful at worst, depending upon how many ‘bad’ cells are being destroyed, but the key words here are ‘bad cells’ and ‘destroyed’.

After sitting around with your head encased in Saran wrap for three hours, six minutes would seem to be a minor epilogue.  However, once your eyes are covered and you’re in the dark, holding a rubber hose that ejects frigid air to play on your head, time slows.  When my fifth treatment entered the cell-destruction stage, I knew what to expect, and time still seemed to stand still.  My scalp began to burn and pain asserted itself in spite of my pitiable efforts to put the fire out with that undersized cold air dispenser.  Not unlike spraying a four-alarm blaze with a garden hose.  When the bell finally rang and the hot light died, I was de-goggled and released.  Afterward, hidden from the sun for a couple of days, my face and scalp turned into a tomato.

Things were once worse, though.  My first treatment at another clinic used Levulan, a similarly-acting, but different chemical.  The light-exposure part of that treatment lasted eight minutes, and I was given a tiny, hand-held battery-powered fan to cool my blistering head.  Even a Navy SEAL would have talked.