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Photodynamic Therapy vs Surgical Excision

Photodynamic Therapy: A light-activated drug applied in the office, then switched on with a lamp or laser. It is the strongest non-drug option for inflammatory acne, and the downtime is a real week.

Surgical Excision: The growth is cut out along with a measured border of normal-looking skin, and the wound is stitched closed. The whole piece goes to a laboratory and the result comes back in about a week. The scar is a line, and it is longer than the spot was.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist
Last updated: 10/22/2026
Editorial illustration for Photodynamic Therapy, based on the entry’s treatment or equipment reference.Editorial illustration for Surgical Excision, based on the entry’s treatment or equipment reference.
Choose ifKey differencesWhat is it?What it treatsTreatment areasSkin tonesHow it worksBefore your treatmentDay of treatmentAfter your treatmentRisksCostQuestionsRelated

Choose Photodynamic Therapy if…

Choose to treat a whole area of sun damage at once — or as a strong non-drug option for stubborn acne — with a real week of downtime.

  • Many precancerous patches on the face or scalp
  • You can stay out of light for 48 hours
  • You can take a week of redness

Choose Surgical Excision if…

Choose to remove a skin cancer or suspicious growth completely with lab-checked edges — the scar is a line, longer than the spot.

  • Melanoma or a suspicious mole
  • Skin cancer on the trunk or limbs
  • You want the whole growth checked
Alternatives, not combined

Can you have both?

They suit different problems. PDT treats a wide area of precancerous change; excision removes a single growth or cancer.

Key differences

● Photodynamic Therapy
● Surgical Excision
DowntimeNone → 2+ weeks
3–7 days
1–2 weeks
PainMinimal → Needs anesthesia or sedation
Moderate
Mild
Results showImmediately → 3+ months
1–4 weeks
Immediately
How long it lastsWeeks → Years or permanent
1–2 years
Years or permanent
Visits neededOne → Every few months
A short series (2–3)
One
Cost per visit$ → $$$$$
$$
$$
ReversibleYes, can be undone → No, permanent
No, permanent
No, permanent

What is it?

Photodynamic Therapy

Surgical Excision

What is it?

It pairs medicine with light.

A photosensitizing medicine is activated by a set light exposure.

It treats precancers.

It is used for actinic keratoses and some superficial lesions.

It differs from LED therapy.

It is not ordinary LED or UV treatment.

Light avoidance is needed after.

Sunscreen alone may not prevent activation.

It removes a lesion surgically.

A planned incision removes the lesion and a rim of tissue.

It diagnoses or treats.

It provides tissue or removes a known lesion.

Margins depend on the diagnosis.

They should not be chosen from a generic chart.

Mohs is different.

Standard excision and Mohs assess tissue differently.

What it treats

Evidence level
Photodynamic Therapy
Surgical Excision
Strong evidenceMost established uses
Existing educational image of Actinic Keratosis

Actinic Keratosis

Clears 75–90% of spots.

Existing educational image of Basal Cell Carcinoma

Basal Cell Carcinoma

High cure rates.

AI-generated educational illustration: Crusted red raised lesion on a light-skinned sun-exposed hand.

Squamous Cell Carcinoma

Removes the cancer with margins.

AI-generated educational illustration of Melanoma: 1. Melanoma Header — Light Skin; Lighter skin. Not a clinical photograph.

Melanoma

The main treatment.

A smooth, dome-shaped lump about two centimetres across on the upper back on pale skin, with a tiny dark pore at its center and faintly pink skin over it.

Epidermal Inclusion Cyst

Removes the sac.

Moderate evidenceSome supportive research
Existing educational image of Basal Cell Carcinoma

Basal Cell Carcinoma

Treats superficial types.

—
Limited evidenceEarly or small studies
Inflamed acne on light skin. The spots sit in a patch of pink, and the ring of redness around each one is easy to see. A few have a yellow-white head, and the skin between them is dry and flaking.

Acne

Used for stubborn acne.

—
Little evidence
—
Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

Acne Scarring

Punch excision is used for small scars instead.

Not effective
AI-generated educational illustration of Melanoma: 1. Melanoma Header — Light Skin; Lighter skin. Not a clinical photograph.

Melanoma

Needs excision.

—
Can make it worse
Flat tan patches with soft irregular edges across the forehead and upper cheek of an adult with light skin, the surface completely smooth.

Melasma

Light can darken patches.

A raised, smooth, firm scar on the upper chest on light skin. It is shiny pink-red and hairless, and its edges spread well past the small mark it grew from.

Keloids

Keloids often return larger alone.

Treatment areas

Treatment areas

Face; the selected area depends on the concern and treatment plan.

The specific lesion, scar or affected patch determines the treatment site; there is no fixed body distribution.

Skin tones

Skin tone
● Photodynamic Therapy
● Surgical Excision
Lighter skin
Low risk
Redness and peeling.
Low risk
A fine line scar.
Medium skin
Some risk
Temporary darkening possible.
Low risk
Scar fades over a year.
Deeper skin
Some risk
Dark marks are more likely; strict light avoidance helps.
Some risk
Raised or keloid scars possible, especially on chest, back and shoulders.

How it works

Photodynamic Therapy

Surgical Excision

How it works
Photodynamic Therapy mechanism diagram. A photosensitizer is applied: The selected medicine accumulates in the prepared treatment area. Light activates the medicine: A matched light regimen produces reactive molecules. Selected cells are damaged: Inflammation and healing follow; treatment response varies.
Surgical Excision mechanism diagram. The area is planned: Diagnosis and location guide the removal border and depth. The lesion is cut out: The clinician removes the selected tissue as a specimen. Closure and tissue review follow: The wound heals, while pathology helps guide further care.
Diagram explanation

A photosensitizer is applied: The selected medicine accumulates in the prepared treatment area. Light activates the medicine: A matched light regimen produces reactive molecules. Selected cells are damaged: Inflammation and healing follow; treatment response varies.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

The area is planned: Diagnosis and location guide the removal border and depth. The lesion is cut out: The clinician removes the selected tissue as a specimen. Closure and tissue review follow: The wound heals, while pathology helps guide further care.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

Before your treatment

Photodynamic Therapy
Surgical Excision
2–4 weeks before

2 weeks before: Sun and tanning: Avoid sun and tanning for 2 weeks.

Before you book: Time off: Clear several days, especially the 48 hours after, when you must stay out of sunlight and bright indoor light.

Not specified
The week before

5 to 7 days before: Actives: Stop retinoids and exfoliating acids.

Supplements and alcohol: Non-essential blood thinners such as fish oil, vitamin E and ginkgo are commonly stopped about a week before, and alcohol the night before.

Smoking and vaping: Stop for a week before and two weeks after if you can.

Day of treatment

Photodynamic Therapy
Surgical Excision
Before you arrive
Not specified

Eating and clothes: Eat normally and take your usual morning medicines.

Arrival & prep

Photos, consent covering the off-label use and the downtime, and a medication review.

The site is confirmed against the biopsy report and you point to it yourself.

Treatment

Skin is cleaned and degreased, sometimes with microdermabrasion or an acetone wipe, so the drug soaks in evenly.

The solution goes on and you wait 20 minutes to 3 hours in a dim room. Then eye shields go on and you sit under a blue or red light for 8 to 20 minutes, or a laser or IPL is passed over. Stinging builds and peaks at the end; cold air helps.

The surgery: The skin is cleaned and draped.

The surgery: The ellipse is cut out in one piece, bleeding points sealed, and the edges freed so they meet without tension. Closing is in layers — dissolving stitches deep, stitches on the surface. You feel pressure and tugging and hear instruments, but nothing sharp. Most take 20 to 45 minutes, and the site feels tight afterward rather than sore.

Before you leave

The least comfortable procedure on this list.

A dressing, written wound care, a stitch removal appointment, and a plan for how the pathology result reaches you.

After your treatment

Photodynamic Therapy
Surgical Excision
First 24 hours

First 48 hours: Stay strictly out of sunlight and bright indoor light; daylight through a window can trigger a severe reaction.

Not specified
Days 2–7

Days 4 to 10: Peeling and flaking, sometimes in sheets.

First week: Keep the dressing dry and in place for 24 to 48 hours, then start daily care — gentle wash, petrolatum, non-stick dressing.

Days 5 to 14: Stitches come out — face at 5 to 7 days, trunk and arms at 10 to 14, legs and back sometimes longer.

Weeks 2–4

Weeks 1 to 2: An acne flare is common in the first week or two, before improvement starts.

From week 2: The scar is hardest, pinkest and most raised at around three to six weeks.

Time to results

2–4 weeks

Lab result in about a week

How long results last

Treated spots clear; new ones may form

Permanent

Risks

Risks
  • Dark patches
  • Prolonged redness
  • A cold sore outbreak
  • A thick, raised or widening scar
  • Numbness or a firm cord under the skin
  • A stitch that surfaces months later
  • A margin that was not clear
  • A pucker at one end of the line
  • When to contact your provider

Cost

Per session

In the US, PDT for acne generally costs about $400 to $1,500 per session, so a course commonly lands between $800 and $4,000.

An excision costs more than a scrape-and-burn and less than Mohs surgery.

Insurance

Insurance does not cover PDT for acne, because the approved indication is precancerous sun damage.

In the US the surgical charge is priced by the size of the excision and the body site, with a separate charge for a more complex layered closure.

Questions

Photodynamic Therapy

Surgical Excision

Individual Questions
Is photodynamic therapy approved for acne?

Not in the US. It is FDA-approved for precancerous sun spots; using it for acne is off-label. That is legal and common, but it means no standard protocol and results that vary between clinics.

How bad is the downtime really?

Plan for 5 to 7 days of a visibly red, then swollen, then peeling face, with the worst in the first 48 hours. It is closer to a medium-depth peel than a laser facial.

Why do I have to stay out of the sun for 48 hours?

The drug is still in your skin, and sunlight — including through a car or office window — activates it and can cause a severe burn. This is the most important instruction of the treatment.

Does it cure acne?

No. Improvement typically lasts 6 to 12 months and repeat courses are often needed. It does not treat scars or existing brown marks.

Is it safe on deeper skin tones?

It can be done, but the risk of lasting dark patches is meaningfully higher, because the treatment works by causing strong inflammation. A shorter incubation, a lower light dose and an experienced provider make a large difference.

Why is the scar so much longer than the spot?

Because a round hole cannot be closed flat. The piece taken out is an ellipse roughly three times as long as it is wide, so the edges meet evenly instead of puckering at each end. A spot the size of a pencil eraser becomes a line an inch or more long. It is geometry, not technique, and no surgeon avoids it.

How long until I get the result?

Usually 3 to 10 days, depending on the laboratory. Ask before you leave how and when you will be told, and call if you have heard nothing after about two weeks.

What happens if the margins are not clear?

A further procedure — a re-excision with a wider border, or a referral for Mohs surgery — usually within a few weeks. It is not a mistake. It is the reason the specimen went to a laboratory in the first place.

When can I exercise again?

About 2 weeks for most sites, longer for the back, shoulder and shin. The visible stitches come out sooner, and the deep stitches are still carrying the tension. Lifting or straining is what stretches or splits a wound.

Should I have Mohs surgery instead?

On the face, particularly the nose, eyelids, ears and lips, or for a tumor that is large, has vague borders, has an aggressive subtype on the biopsy, or has come back before, Mohs is often better. For a small low-risk cancer on the trunk or limbs, an excision achieves the same result in a fraction of the time and cost. Ask which category yours is in.

Will the scar fade?

It flattens and pales substantially over about a year, with most of the change in the first six months. Keeping it out of the sun and using silicone gel or sheeting once it is closed are the two things with reasonable evidence behind them. Scars on the chest, shoulders and upper back stay red and raised longest and are the likeliest to widen.

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