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Background Basal cell carcinoma (BCC) may be difficult to treat by conventional means, particularly if the lesions are large or located in the mid‐face (H‐zone). Photodynamic therapy (PDT) using topical methyl aminolaevulinate (MAL) may be a good noninvasive option for these patients.

Objectives To investigate the efficacy and safety of PDT using MAL for BCCs defined as ‘difficult to treat’, i.e. large lesions, in the H‐zone, or in patients at high risk of surgical complications.

Methods This was a prospective, multicentre, noncomparative study. Patients were assessed 3, 12 and 24 months after the last PDT treatment. One hundred and two patients with ‘difficult‐to‐treat’ BCC were treated with MAL PDT, using 160 mg g⁻¹ cream and 75 J cm⁻² red light (570–670 nm), after lesion preparation and 3 h of cream exposure.

Results Ninety‐five patients with 148 lesions were …