Radiation Therapy for Skin Cancer

Non-melanoma skin cancer (which includes basal and squamous cell carcinoma) is the most common form of cancer worldwide. In the United States alone, more than 5 million people are treated for skin cancer per year. In fact, there are more cases of skin cancer diagnosed annually than breast, lung, colon and prostate cancer diagnoses combined.

As rates of skin cancer diagnoses in the U.S. continue to rise, and the Baby Boomer generation reaches late middle-age, the role of radiation therapy in the treatment of non-melanoma skin cancer has become more important.

While surgery alone is often the right choice, especially in very young patients, for non-melanoma skin cancer, radiation therapy may be the best option in many cases.

Radiation therapy may be given as a primary treatment or as an adjunct to surgery for squamous cell and basal cell carcinomas.

At SERO, we work closely with our dermatologic surgical colleagues to diagnose, plan, and execute the best radiation treatment approach for each and every patient. 

To help determine if radiation therapy is right for you, we discuss what it is, how it’s used, and its benefits. 

Contents

What is Radiation?

Radiation therapy, often referred to as radiotherapy, is a medical technique used to treat, control, and/or cure certain kinds of cancer. It delivers invisible rays of high-energy radiation into malignant cancer cells. This process works by damaging the DNA inside the cell, which causes the cell to die.

Radiation therapy can be used as a curative treatment for many different kinds of cancer, especially when the cancer is localized in one area of the body, such as basal cell carcinoma, and has not yet spread to other areas.

Radiation therapy is also commonly used as an adjuvant therapy. Adjuvant therapy refers to medical treatments that are given in addition to the primary or initial type of treatment in the hopes of optimizing its effectiveness. 

For example, a patient with cancer that has spread to multiple parts of the body may undergo chemotherapy to attack the disease as a whole, while using radiation therapy to target specific tumors or clusters of cells.

For non-melanoma skin cancer, radiation therapy can be delivered with superficial penetrating electron beam or orthovoltage beam. These technologies deliver precise doses of radiation that can penetrate in shallow, highly targeted areas, making them ideal for treating cancers of the skin.

Surgery vs Radiation Therapy for Skin Cancer

Historically, surgery has been the most common way to treat non-melanoma skin cancer, particularly for minor, early-stage cases. Since basal and squamous cell carcinomas tend to start small, are slow-growing, and frequently do not spread right away, surgery may offer the best treatment.

For these reasons, surgery is often an excellent option. Through various surgical procedures, including Mohs surgery, cryosurgery, and curettage with electrosurgery, a physician can quickly remove the cancer before it grows, spreads, or causes additional damage. The effectiveness of each surgical approach is different, but all have very high curative rates.

At the same time, radiation therapy provides an excellent treatment option for skin cancer, either as an alternative to surgery or an adjunctive treatment in combination with surgery. 

In many cases, radiation therapy may be used in place of or in combination with surgical options. Depending on a patient’s specific medical situation, overall health, age, and preferences, radiation therapy may be the best option available.

If you’ve got basal or squamous cell carcinoma, you’ll want to talk to your doctor and cancer team about the options that are best suited for your particular case. Several highly effective treatments are available, and your best choice will depend on your circumstances and preferences.

Factors to consider when choosing a treatment for skin cancer include:

  • Size of tumor
  • Location of cancer
  • Type of cancer (squamous or basal cell)
  • Age
  • Health
  • Whether you’ve had skin cancer before in the same spot
  • Whether you’ve had radiation therapy before

When Radiation Therapy May Be the Best Skin Cancer Treatment

Radiation therapy provides a safe, effective treatment for basal and squamous cell carcinoma in many cases. It may be the best treatment option for:  

  • Patients have skin cancer in delicate sites on the face, such as those around the nose, eyes, ears, or lips, where surgical defects may harm the area or cause undesirable cosmetic damage.
  • Patients who have skin cancer that has been treated but has come back in the same location.
  • Patients with high-risk squamous cell and basal cell lesions that have close positive margins, nerve invasion, high growth rate, or the possibility of nodal involvement.
  • Patients who have large skin cancer tumors that cover a large area.
  • Older adults (over the age of 60).
  • Patients who have poor overall health or underlying medical conditions that could lead to complications from surgery.
  • Patients on blood thinners or other medications that interfere with surgery.

Benefits of Radiation Therapy for Skin Cancer

While slightly less curative than surgery, radiation therapy has a very high rate of success. 

Radiation therapy may be the most effective option for high-risk squamous cell and basal cell lesions that have close positive margins, nerve invasion, high growth rate, or the possibility of nodal involvement.

Radiation therapy may also be very effective as an adjuvant therapy in combination with other cancer treatment options, optimizing the effectiveness of both.

As a primary treatment option, radiation therapy for skin cancer has many benefits, including: 

  • Radiation therapy does not cause scarring and typically results in little, if any, cosmetic damage.
  • Radiation therapy may be used to target cancers in delicate areas, particularly near the eyes, nose, ears, and mouth.
  • Radiation therapy allows patients to continue taking medications that might cause complications during surgery, such as blood thinners.
  • Treatments are short and painless.
  • Healing at the tumor site generally occurs in two to six weeks after the end of therapy and doesn’t leave significant scarring.
  • There is no risk of infection, a particularly important benefit for elderly patients and those with poor overall health or serious medical conditions.
  • Radiation therapy for skin cancer is generally approved by all major insurance companies, including Medicare.
  • Side effects are generally mild and tend to go away quickly.
  • Radiation therapy avoids the extreme surgical defects that may result in very large tumors that are treated with surgery.
  • Radiation may be used after surgery to improve the control rate of the cancer in high risk scenarios.
  • Anticipated use of radiation may allow a surgeon to forego extensive surgical grafts, flaps or reconstruction if the combined modality approach is known ahead of time.

What to Expect With Radiation Therapy

Radiation provides a nonsurgical approach that requires 15-minute sessions daily for three to five weeks to deliver the treatment. The tumor will slough off during this period along with some adjacent normal skin, but these areas will generally heal with new skin with a smooth surface in the ensuing two to six weeks.

Although radiation therapy requires more visits than surgery, there is no need for anesthesia or cessation of medicines that might cause complications during surgery. Treatments are brief and painless.

Radiation may also be used following surgery for high-risk squamous cell and basal cell lesions that have close positive margins, are large, include nerve invasion, have a high growth rate, or include the possibility of nodal involvement. Radiation used after surgery improves the control rate beyond surgery alone in these high-risk scenarios.

The SERO Approach to Treating Skin Cancer with Radiation

As radiation oncologists, we coordinate with the physicist and treatment planning team to personalize the therapy to cover the exact depth and perimeter of the skin cancer with a very small border of normal skin. This will effectively eradicate the cancer while disturbing as little normal tissue as possible. Generally, photos are taken before, during and after the treatment for documentation and to aid in follow-up.

SERO has a long history of treating skin cancers given the high rate of skin cancer in the Carolinas and our greater than 30-year history of serving this region. Challenging and difficult cases are frequently presented in tumor board forums with many cancer specialists present to aid in acquiring the most current information available. Second opinions and multidisciplinary panels are so vitally important yet easy to obtain for all challenging skin cancer cases.