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Transcript of Skin cancer video
Radiation Treatment of Skin Cancer (basal or squamous)
Robert Miller MDwww.aboutcancer.com
Does it work? What are the results? What are the side effects?
Basal Cell Carcinoma
Basal cell carcinoma (BCC): About 80% of all skin cancers are BCC, a cancer that develops in the basal cells - skin cells located 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 tend to grow slowly and can take years to reach ½ inch in size. While these tumors very rarely metastasize
Squamous Cell Carcinoma
Squamous cell carcinoma (SCC): About 16% of diagnosed skin cancers are SCC. This cancer begins in the squamous cells, which are found in the upper layer of the epidermis. SCC tends to develop in fair-skinned middle-aged and elderly people who have had long-term sun exposure
Literature Review (untreated basal cell)
TechniqueNumber of
CasesLocal Control
surgical excision 2,606 90%
radiation therapy 4,695 91%
curettage and electr.
3,573 92%
cryotherapy 269 93%
Mohs' microsurgery
7,670 99%
Literature Review (recurrent basal cell)
TechniqueNumber of
CasesLocal Control
surgical excision 522 83%
radiation therapy 234 87%
curettage and electr.
115 60%
Mohs' microsurgery
3,009 94%
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 Cell
87% 65%
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 Rx
Features Mohs Other
2cm or larger 75% 58%
Recurrent 90% 77%
Poorly Diff. 67% 46%
Perineural 92% 53%
SurgeryCosmetic Results and Comparisons
Surgery
Mohs surgery then flap
Patient treated with Surgery. Generally the cosmetic results of radiation are better than surgery if a skin graft is required
Site of skin graft
Often the long term cosmetic results with radiation will be superior to surgery on the nose
Radiation may get better cosmetic results than with surgery
Radiation for Skin Cancer
Electron beam for large areas. Daily (Mon-Fri) for 3 – 6 weeks
A block or shield is made to expose the skin that needs to be treated with electrons
A Shield is Designed to Block the Radiation from hitting the normal skin and just the target area
How many treatments?
Basal Cell And Radiation
Generally small cancers heal quickly
Squamous cancer on the leg , healing may be slower on the legs
Cosmetic Results. In most patients there is no visible sign of treatment after radiation
Radiation for squamous cancer of the ear
Radiation for basal cell cancer of the forehead
Sometimes the treated area looks more pale than the rest of the skin
Before radiation 1 month after radiation
Radiation is good for large areas on the scalp that would have required a skin graft
Years after radiation the skin may look more pale
93 yo woman this area was treated with radiation 9 years before
HDR = high dose rate machine that can run radiation through a tube that reaches the patient through skin applicators
Radiation for Skin Cancer
HDR skin applicators – three times a week for 6 treatments over a two week period
The HDR Skin applicator is taped in place over the cancer
The applicator is attached by cable to the machine that makes it radioactive for a few minutes
HDR for Skin Cancer on the Shin
HDR for Skin Cancer on the Foot
HDR for Skin Cancer on the Foot
78 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 of the skin 10 months after radiation
Small squamous cancer of the chin, appearance 3.5 weeks after radiation (HDR)
Skin 12 months after radiation
Results with HDR for skin on shin
86 yo woman with small basal cell on her shin, 5 months after HDR
86 yo woman
Radiation for areas difficult to operate, squamous cancer of the finger before and 19 days after electron beam
Even large or neglected skin cancers usually heal well with radiation
Appearance at 2 months
Appearance at 3 months
Appearance at 5 months
A large , neglected basal cell cancer on the left side of the nose, healed completely with radiation, avoiding major surgery
Side Effects of Skin Radiation
The treated skin will get red, itchy and sunburned. There are a number of good creams than can be used including Aloe, Aquaphor, Sween, Biafine, or Silvadene
The skin reaction may show up in a delayed manner (worse at 1-2 weeks) and may develop slight, superficial ulceration or crusting, but heals quickly (1-2 weeks) except the shin which heals more slowly
Side Effects of Skin Radiation
Side Effects of Skin Radiation
Last day of treatment (large electron beam fields for basal cell…55Gy
With electron beam the skin will get moderately sun-burned by the last day, but usually heals up in 2 to 3 weeks
Side Effects of Skin RadiationBY the last day the skin may be sunburned and slightly blistered with some drainage… about a week after stopping radiation it starts to heal quickly and usually by 3 weeks there is just some dry crusting or scabbing remaining
The radiated skin will get sunburned
Radiation target Last day of treatment
First day Last day
Two weeks Two Years
Side Effects of Skin Radiation
The radiated skin will get sunburned
Before Radiation Last Day
Large area of recurrent basal cell , before and on the last day of electron beam radiation , this usually heals up by 2 to 3 weeks
Along with skin redness, there may be some crusting and peeling of the skin
Obvious cancer
Same patient three weeks later
Radiation Side Effects from HDR on the Forehead
1st day 1 week after 3 weeks
Squamous cancer last day of radiation
1 month later 7 months later
Time to healing after high dose electron beam radiation
Recurrent Basal cell cancer on the left forehead of an elderly woman
Time to skin healing
Often the peak skin reaction shows up about two weeks after completing the radiation (esp with HDR)
Delayed Skin Reaction with HDRcancer over the shin in elderly patients may take weeks to months to heal up completely
The scab may take a few weeks to fall off
Typical time period
82 yo woman with squamous
cancer 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 temple
First day Last Day Radiation 3 weeks later
Radiation will result in hair loss over the scalp, it does not always grow back
Before radiation 3 weeks after completion
Radiation Treatment of Skin Cancer (basal or squamous)
Robert Miller MDwww.aboutcancer.com