Published on March 3, 2013
Radiation Treatment of Skin Cancer (basal or squamous) Robert Miller MD www.aboutcancer.com Does it work? What are the results? What are the side effects?
Basal Cell CarcinomaBasal cell carcinoma (BCC): About 80% of all skin cancersare BCC, a cancer that develops in the basal cells - skin cellslocated in the lowest layer of the epidermis.Most BCCs appear on skin with a history of exposure to the sun,such as the face, ears, scalp, and upper trunk. These tumors tendto grow slowly and can take years to reach ½ inch in size. Whilethese tumors very rarely metastasize
Squamous Cell CarcinomaSquamous cell carcinoma (SCC): About 16% of diagnosed skincancers are SCC. This cancer begins in the squamous cells, whichare found in the upper layer of the epidermis. SCC tends to developin fair-skinned middle-aged and elderly people who have had long-term sun exposure
Literature Review (untreated basal cell) Number of Technique Local Control Casessurgical excision 2,606 90%radiation therapy 4,695 91% curettage and 3,573 92% electr. cryotherapy 269 93% Mohs 7,670 99% microsurgery
Literature Review (recurrent basal cell) Number of Technique Local Control Casessurgical excision 522 83%radiation therapy 234 87% curettage and 115 60% electr. Mohs 3,009 94% microsurgery
Control Rate with Radiation, 3 Large Series Basal Cell 98% 95% 96%Squamous Cell 92% 87% 88% Control Rates with Radiation Type Untreated Relapsed Basal Cell 95% 82% Squamous 87% 65% Cell
Control by Tumor Size with Radiation Size Control Rate < 2 cm 99% 2 - 5 cm 92% > 5 cm 60% Skin Damage with Radiation Size Skin Damage < 1cm 0.9% 1 - 5 cm 6.5%
Mohs Surgery for High Risk Squamous /Cure Rates Comparing Mohs and other RxFeatures Mohs Other2cm or larger 75% 58%Recurrent 90% 77%Poorly Diff. 67% 46%Perineural 92% 53%
Cosmetic Results and Comparisons Surgery
Patient treated with Surgery. Generally the cosmetic results ofradiation are better than surgery if a skin graft is required Site of skin graft
Often the long term cosmetic results withradiation will be superior to surgery on the nose
Radiation may get better cosmetic resultsthan with surgery
Radiation for Skin CancerElectron beam for largeareas. Daily (Mon-Fri) for 3– 6 weeks
A block or shield is made to expose theskin that needs to be treated with electrons
A Shield is Designed to Block the Radiation fromhitting the normal skin and just the target area
How many treatments?
Basal Cell And Radiation
Generally small cancers heal quickly
Squamouscancer onthe leg ,healingmay beslower onthe legs
Cosmetic Results. In most patients there isno visible sign of treatment after radiation
Radiation for squamous cancer of the ear
Radiation for basal cell cancer of theforehead Before radiation 1 month after radiation Sometimes the treated area looks more pale than the rest of the skin
Radiation is good for large areas on the scalpthat would have required a skin graft
Years after radiationthe skin may look morepale93 yo woman this areawas treated withradiation 9 years before
HDR = high dose rate machine that canrun radiation through a tube that reachesthe patient through skin applicators
Radiation for Skin CancerHDR skin applicators – three times a weekfor 6 treatments over a two week period
The HDR Skin applicator is taped inplace over the cancer
The applicator is attached by cable to the machine thatmakes it radioactive for a few minutes
HDR for SkinCancer on theShin
HDR for Skin Cancer on the Foot
HDR for Skin Cancer on the Foot78 yo woman with squamous cancer
Results with HDR Skin applicator for small basal cell cancers on the face
HDR for Basal Cell on the Nose, appearance ofthe skin 10 months after radiation
Small squamouscancer of the chin,appearance 3.5weeks afterradiation (HDR)
Skin 12 months afterradiation
Results with HDR for skin on shin
86 yo woman with small basal cell on hershin, 5 months after HDR
Radiation forareas difficult tooperate,squamous cancerof the fingerbefore and 19days afterelectron beam
Even large or neglected skin cancers usually heal well with radiation
Appearanceat 2 months
Appearance at3 months
Appearance at 5 months
A large ,neglectedbasal cellcancer on theleft side of thenose, healedcompletelywith radiation,avoiding majorsurgery
Side Effects of Skin RadiationThe treated skin will get red, itchy and sunburned. Thereare a number of good creams than can be used includingAloe, Aquaphor, Sween, Biafine, or SilvadeneThe skin reaction may show up in a delayed manner(worse at 1-2 weeks) and may develop slight, superficialulceration or crusting, but heals quickly (1-2 weeks)except the shin which heals more slowly
Side Effects of Skin Radiation
Side Effects ofSkin RadiationLast day oftreatment (largeelectron beamfields for basalcell…55Gy
With electronbeam theskin will getmoderatelysun-burnedby the lastday, butusually healsup in 2 to 3weeks
Side Effects of Skin RadiationBY the last day the skin may be sunburned and slightlyblistered with some drainage… about a week after stoppingradiation it starts to heal quickly and usually by 3 weeks thereis just some dry crusting or scabbing remaining
The radiated skin will get sunburnedRadiation target Last day of treatment
First day Last dayTwo weeks Two Years
Side Effects of Skin Radiation
The radiated skin will get sunburned Before Radiation Last Day
Along with skin redness, there may be somecrusting and peeling of the skin Obvious cancerLarge area of recurrent basal cell , before and on the last day ofelectron beam radiation , this usually heals up by 2 to 3 weeks
Same patientthree weekslater
Radiation Side Effects from HDR on theForehead1st day 1 week after 3 weeks
Time to healing after high doseSquamous cancer last day of radiation electron beam radiation 1 month later 7 months later
RecurrentBasal cellcancer on theleft foreheadof an elderlywoman
Time to skin healing
Often the peak skin reaction shows up abouttwo weeks after completing the radiation (espwith HDR)
Delayed Skin Reaction with HDRcancer over the shin in elderly patients maytake weeks to months to heal up completely
The scab may take a few weeks to fall off
Typical time period 82 yo woman with squamouscancer on the shin treated with electron beam radiation
Cancers on the shin in elderly patients can be slow to heal
Sometimes the skin superficially ulcerates, 76 yo man with recurrent basal cell templeFirst day Last Day Radiation 3 weeks later
Radiation will result in hair loss over thescalp, it does not always grow back Before radiation 3 weeks after completion
Radiation Treatment of SkinCancer (basal or squamous) Robert Miller MD www.aboutcancer.com
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