Non-Melanoma Skin Cancer

• Understanding the disease
• Treatment options
• Side effects of treatment

Stephen Shamp, MD MSEE

David Bloom, MD PhD

Matthew Culbert, MD

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. BCC can take several forms.

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. It most often appears as a crusted or scaly area of skin with a red inflamed base that resembles a growing tumor, non-healing ulcer, or crusted-over patch. SCC requires early treatment to prevent metastasis (spreading).

www.nccn.org

RT = radiation therapy

RT = radiation therapy

RT = radiation therapy

Literature Review (untreated basal cell)

Control by Tumor Size with Radiation

Skin Damage with Radiation

Comparison with Surgery

Radiation Therapy

Surgery

Cosmetic Results and Comparisons

Surgery

Mohs surgery then flap

Surgery on the Forehead with Skin Graft

Patient treated with Surgery. Generally the cosmetic results of radiation are better than surgery if a skin graft is required

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

Procedure Details

Radiation Therapy

Radiation for Skin Cancer

Electron beam for large areas. Daily (Mon-Fri) for 4 – 6 weeks

Basal Cell Cancer

​

A radiation field in blue is set up with a margin of 1 to 2cm around the obvious skin cancer that will cover any small areas of spread of the skin cancer

A Shield is Designed to Block the Radiation from hitting the normal skin and just the target area

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

• Lasers and/or imaging is used to precisely deliver the daily radiation treatment.
• Expect to be on the treatment table less than 15 minutes.
• You will not feel any immediate effects.

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 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 Hand

Logistics of Superficial Electron treatment:

• Usually 20-35 treatments once per day, over 4 to 7 weeks
• Treatment days are Monday-Friday 5 days per week
• Daily treatment takes 15 minutes or less. You will be given a schedule
• You do not feel anything during treatment, you will not be radioactive, you are allowed to drive yourself to and from treatment if you are currently allowed to drive

• Lasers and/or imaging is used to precisely deliver the daily radiation treatment.
• Expect to be on the treatment table less than 15 minutes.
• You will not feel any immediate effects.

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

Skin reaction, first day and last day

Side Effects of Skin Radiation

First day of radiation Last day of radiation

cancer

Radiation�zone

Side Effects of Skin Radiation

Most patients get very good cosmetic results after radiation

Years after radiation the skin may look more pale

​

93 yo woman this area was treated with radiation 9 years before

The skin can look slightly discolored after 2 or 3 years (93 yo man with HDR for basal)

Before 2.5 years

Nose

Radiation Therapy Results

Basal Cell on the nose and Radiation

Cosmetic Results. In most patients there is no visible sign of treatment after radiation

Basal Cell Left Side of Nose

1st week

2nd week

3rd week

One month

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

First day

Half way

Last day

2 months

Basal

cell

Skin 12 months after radiation

91 yo woman with basal cell on nose

Basal Cell Left Nose

Before

After

95 yo woman with small basal cell

90 y old woman, small basal cell, 5 weeks after HDR

91 yo with squamous cancer on nose

​

Brisk radiation reaction but excellent cosmetic result at 2 months

First day Last day

Two weeks Two Years

87 yo with Basal Cell Cancer Left Nose

First day

Last day

3 weeks later

Ear

Radiation Therapy Results

With electron beam the skin will get moderately sun-burned by the last day, but usually heals up in 2 to 3 weeks

Basal Cell Cancer of the Ear

Radiation for squamous cancer of the ear

Lip

Radiation Therapy Results

Cosmetic Results. In most patients there is no visible sign of treatment after radiation

Squamous Cancer of the Lip

Face

Radiation Therapy Results

Basal Cell And Radiation

Radiation Side Effects from HDR on the Forehead

1^st day 1 week after 3 weeks

Time to skin healing

Squamous Last day of radiation

3 weeks 4 months

Scalp

Radiation Therapy Results

Radiation is good for large areas on the scalp that would have required a skin graft

96 yo man with squamous cancer on scalp shown before and 3 years after scalp radiation

80 yo man with Squamous Cancer on Scalp

First Day 3 Months after XRT

3 weeks later

80 yo male with multiple SCC of scalp. 20 fractions electron radiation

Last day

Eye

Radiation Therapy Results

Radiation for basal cell cancer of the upper eyelid, appearance 3 years after radiation

Long term results for advanced basal cell

Extremity

Radiation Therapy Results

Generally small cancers heal quickly

Radiation is usually effective for skin cancers on the hands or fingers

Squamous cancer on the leg , healing may be slower on the legs

Squamous Cancer Finger before and last day of radiation in 85 yo old woman

1 month later

HDR for Skin Cancer on the Foot

78 yo woman with squamous cancer

Results with HDR for skin on shin

Basal Cell Treated with HDR

69 yo man with diabetes

1^st treatment

5 weeks

3 months

71 yo man with squamous cancer on the shin

76 yo man with squamous cancer inner left foot, treated with HDR

1^st day 4 weeks 13 months

87 yo with Squamous Cancer at 1 month

Basal Cell on Leg at One Year, less color (achromia)