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