Several studies have reported the efficacy of photodynamic therapy (PDT) in the treatment of non-melanoma skin cancer (NMSC) and pre-cursor lesions, such as actinic keratosis (AK). Recent studies investigating the use of methyl aminolevulinate (MAL, Metvix PDT have made comparisons to existing standard treatments for basal cell carcinoma (BCC) and AK in terms of efficacy, adverse events and cosmetic outcome. This review considers these studies as a body of evidence that supports the use of MAL PDT over traditional therapies in these conditions. The data thus far show PDT to be superior to cryotherapy, 5-fluorouracil (5FU) and excisional surgery in terms of cosmetic outcome, and equivalent in efficacy to other treatment modalities in managing AK and BCC. The studies also show an advantage in the treatment of extensive lesions.