OBJECTIVES: Basal cell carcinoma (BCC) is a common malignant tumour, usually treated with surgery though the cosmetic appearance of the treated lesions can be poor. Methyl aminolevulinate cream is the first topical PDT therapy licensed in the UK for superficial, or mid-face, large or recurrent nodular BCC and can be considered for lesions unsuitable for surgery. The aim of this evaluation was to assess the cost-effectiveness of MAL-PDT versus excision. METHODS: Clinical outcomes were from a comparative trial of nodular BCC. The clinical response for MAL-PDT from a non-comparative trial of primary superficial BCC (Horn et al, in press) was also used to reflect the subgroup most likely to be treated with MAL-PDT. Lesion reoccurrence was derived from published literature and an expert Delphi panel provided resource use. The NHS perspective was taken and only direct costs were considered. Decision analysis was used with MAL-PDT or excision as first line therapy and, if no lesion response, second line therapy. A one-year time horizon was used to capture all relevant outcomes. Excellent cosmetic outcome was defined as 100% complete lesion response, with no scarring, atrophy or induration, and no or slight occurrence of redness or change in pigmentation compared to adjacent skin. Clinical data from the trials were subjected to stochastic sensitivity analysis. RESULTS: From the deterministic model, 69% of nodular BCC patients had an excellent cosmetic outcome with MAL-PDT at a cost of £988.47 per patient compared to 36% of patients treated by excision (£772.91 per patient). Substituting the superficial BCC efficacy data, the cost of MAL-PDT was found to be £890.35 with a 75% excellent cosmetic outcome. In the stochastic analysis using 1000 simulations, 95% of the ICERs calculated were in the range £17 to £2816. CONCLUSIONS: MAL-PDT is advantageous for cosmetically sensitive areas such as lesions on the face and has comparable costs.