Superficial Radiation Therapy | Skin Cancer

May - National Skin Cancer Awareness Month

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Skin Cancer Disease, Diagnosis and Treatment

It is estimated that over 2.8 million new skin cancer cases are diagnosed annually worldwide and will continue to increase at a rate of 4% each year. Over 95% of these skin cancers are basal or squamous cell carcinomas. Other skin cancer categories include mycosis fungoides, Kaposi's sarcoma, Paget's disease and aprocrine carcinoma. The annual death rate from skin cancer in the United States is approximately 10,000. The primary treatment options providing both high cure rate and low recurrence include surgery and non-invasive superficial x-ray therapy. Annual worldwide medical expenditures for treating skin cancer exceed $2.5B.

The incidence of skin cancer has steadily increased over the past 75 years. During the 1930's, 1 in 1500 developed skin cancer. In 1960, the rate had risen to 1 in 600 and in 2000, the rate increased to 1 in 66. The National Cancer Institute estimates that 1 out of 7 are now at risk for developing some form of skin cancer during their lifetime. Increased exposure to the sun without skin protection and a decreasing natural ozone layer are cited as the chief causes of this increase.

Skin cancer, like all cancers, takes a long time to develop from a single mutated cell to a visible change seen on the skin. Older adults are more susceptible. 50% of skin cancer cases occur in adults aged over 60, with males more at risk than females by a factor of two. The US Census Bureau projects that by the year 2025 the over 60-age group will double in size from the year 2000. This is further evidenced by the rising number of nursing convalescent homes for the aged, which has steadily increased to over 17,000 in the United States.

Clinical Use of Superficial Radiotherapy (SRT)

The traditional methods for treating skin cancer with proven high cure rates above 90% - 95% and low recurrence of less than 10% involve surgical procedures and non-invasive Superficial Radiotherapy (SRT). Although other treatment methods are emerging, many are still in development stages requiring further clinical studies for cure rate/recurrence outcomes and evaluation of after-effects such as edema, permanent pigment loss, atrophy, hypertrophic scarring, motor and sensory neuropathy. SRT has been a proven skin cancer treatment method treating basal and squamous cell carcinomas since the 1950's providing a high cure rate and low recurrence. Medicare part B and most insurance carriers readily accept SRT treatment for reimbursement. SRT becomes a logical choice for primary lesions that otherwise require difficult or extensive surgery with sensitive structures in the head and neck regions - the fold in the nose, eyelids, lips, corner of mouth, and the lining of the ear that would otherwise lead to a poor cosmetic outcome. SRT treatment procedures do not require the use of anesthetics and eliminates the need for skin grafting when surgery would result in an extensive defect. Cosmetic results are rated excellent in comparison to other treatments with a small amount of hypopigmentation or telangiectasia at the treatment site.

Superficial X-ray Therapy is most advantageous for the treatment of non-melanoma skin cancers in the head and neck region and/or combined with the following patient situations:

1. Patients who refuse surgery due to fear of surgery or needle phobia.
2. Patients who may not be medically fit for surgery, who may have contraindications for reconstructive surgery such as patients receiving anti-coagulants and patients unfit for general anesthesia.
3. Patients in who x-ray therapy may give a better cosmetic outcome, especially in the linings of the ear, the folds in nose, the lip and corners of the mouth.
4. Patients in who x-ray therapy may provide a simpler option than extensive reconstructive surgery involving skin grafting.
5. Patients in who surgery may cause nerve damage or functional impairment such as tumors overlying the spinal accessory nerve or marginal mandibular nerve.
6. Patients with deep or lateral marginal involvement following excision of tumors where surgery is not feasible or not likely to be tolerated or refused.
7. Patients who have a high risk of residual microscopic size disease such as a patient with a completely excised tumor with perineural invasion and no clinical signs or following surgery of poorly differentiated squamous cell carcinomas.
8. Patients with small volume or marginal recurrent disease following surgery which may require x-ray treatment of the full length of the scar and a safe margin clearance.