48 Photodynamic therapy (PDT) is emerging as a viable non-surgical alternative for treating basal cell carcinoma (BCC), particularly in patients who are unable or unwilling to undergo surgery. BCC is the most common form of skin cancer, predominantly affecting individuals over the age of 50. The disease is often linked to prolonged UV exposure and accounts for a substantial proportion of skin cancer cases globally. The findings were published in the American Journal of Clinical Dermatology. Before a certain wavelength of light is used, a photosensitising agent like 5-aminolevulinic acid (ALA) or methyl-aminolevulinate (MAL) is put on the skin as part of PDT. This process results in the targeted destruction of cancer cells, while preserving the surrounding healthy tissue. The treatment is particularly effective for superficial BCC (sBCC) and, to a lesser extent, for nodular BCC (nBCC), providing patients with excellent cosmetic outcomes, especially for lesions in cosmetically sensitive areas such as the face. Photodynamic therapy is approved for treating actinic keratosis, but it has been increasingly utilised off-label for BCC, especially in low-risk cases. Studies indicate that ALA-PDT and MAL-PDT can achieve complete remission rates of up to 95% for superficial lesions, with recurrence rates varying depending on the tumour type and treatment protocol. In contrast to surgical excision, PDT offers a less invasive approach, making it suitable for older patients or those with comorbidities that increase surgical risks. Mohs micrographic surgery (MMS) remains the gold standard for BCC treatment, especially for high-risk or recurrent cases. It involves the removal of thin layers of skin, which are examined in real time until no cancerous cells remain. This precise approach ensures complete tumour removal while conserving healthy tissue, making it highly effective for poorly defined lesions or those located in areas where recurrence is common. But PDT provides an alternative for patients who may not be suitable candidates for surgery due to medical complications, bleeding risks, or patient preference. One of the significant advantages of PDT over surgical options is its cosmetic benefit. Unlike MMS, which can leave noticeable scarring, PDT is associated with minimal damage to healthy tissue, resulting in better aesthetic outcomes. This makes it a preferred option for treating lesions in visible areas, such as the face and neck. PDT also offers reduced recovery time, making it appealing for patients seeking less disruptive treatment options. Despite these benefits, PDT is not without limitations. Its efficacy is lower for thicker or more invasive BCC types, and the treatment does not provide the margin control necessary to guarantee complete tumour eradication, which is crucial for preventing recurrence. Moreover, patients undergoing PDT often report pain during the light activation phase, and the cost of the photosensitising agents can be a barrier for some. Emerging evidence suggests that PDT may also play a role as an adjunctive therapy in combination with surgical excision. For instance, PDT can be utilised to treat residual BCC cells post-surgery or in cases where complete surgical removal is challenging. This combined approach may enhance treatment outcomes, especially in complex cases where recurrence is likely. Additionally, PDT shows promise for patients with genetic syndromes such as Gorlin syndrome, where multiple BCCs develop over time. In these cases, the non-invasive nature of PDT offers a way to manage lesions without subjecting patients to repeated surgeries, which can be burdensome and lead to significant scarring. Photodynamic therapy represents an important treatment option for basal cell carcinoma, offering a non-surgical approach for patients with superficial, low-risk lesions. While it may not replace surgery for high-risk BCC, its role in managing lower-risk cases and as an adjunctive treatment makes it a valuable addition to the therapeutic arsenal against this common skin cancer. Future research may further refine its applications, standardise treatment protocols, and identify optimal combinations with other modalities to improve patient outcomes.