Video Production by Josh Melendez

Learn about Superficial Radiation Therapy as a treatment for some Non-Melanoma Skin Cancers. Dr. Anderson explains the procedure and its use cases while walking you through the procedure process.

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Video Transcript:

So today we’re going to be talking about the treatment modality of Superficial Radiation to treat select non-melanoma skin cancers.

Now this is a wonderful treatment that’s been around for a hundred years. And dermatologists used to use this procedure all the time. And then Mohs Surgery came around, and Mohs really has become the standard of care for most non-melanoma skin cancers. However, superficial radiation still has a place. And superficial radiation treats a localized area that has a non-melanoma skin cancer in a fashion that’s very different from the radiation that’s typically delivered in hospitals for internal cancers. So if you think about it, if we have just a superficial cancer here, we do not need a radiation source that will go all the way through the hand. All we need is a radiation source that can treat the superficial portion of this, and hence superficial radiation in dermatology.

Now the cure rates for Superficial Radiation Therapy for select non-melanoma skin cancers are about 95 percent. So it’s really good, and the beautiful thing about superficial radiation is it doesn’t require any numbing, it doesn’t require any reconstructive surgery, it doesn’t require any sutures. But it does require you to come into the clinic multiple times over four to six weeks to have the area treated. Now each one of these visits is usually not too long because the actual treatment with radiation is only about 30 to 60 seconds. So before you come into the clinic, we ask that you clean the area that’s going to be treated with a gentle cleanser, and pat dry. We don’t want anything on that area while we’re doing the superficial radiation, because anything that’s on it could impact the radiation getting to the cells or the cancer that need to be treated.

What happens when you come into the clinic is we bring you back into the room, and we put lead shielding on you, just like you would have at the dentist if you were getting x-rays done at your dental office. So we put a lead apron on, and then we localize the area that we’re treating. And we put a lead shield around that, and put lead shields over your eyes, and a lead shield over your thyroid. Now the great thing about this radiation is it’s superficial. It’s not like the radiation that’s used in the hospital to treat lung cancers. This radiation we can dial down the depth to make sure we have a reasonable shot of getting the cancer.

Now a lot of people like to ask, “Say well how do you know that you’ve gotten it all?” Because with most surgical procedures we look at the tissue that was removed under a microscope, when we get a better idea of, if the margins are clear. And for this we do not have a surgical margin that we can look at under our microscope. We then put the machine up to the area. We leave the room, and we literally push a button and watch you from outside the room to make sure you’re okay. You will not feel anything happening during the surgery. In fact, you’ll feel so little of anything you’ll wonder if the machine even turned on, which is awesome.

We then come back into the room, take the lead shields off and let you go home. After the radiation therapy, we do recommend you putting a gentle non-fragrance lotion on to keep the area moist, to help your body to heal and have less symptoms. Now there are some “radiation creams” that you can buy over the internet and all lists below the one I use in my clinic. All you need to do, is after your radiation treatment, put a little bit on the area that’s being treated, and you can repeat that two or three times a day. If you choose not to use the one that I’ve listed below, just get a simple non-fragrance lotion. You can even use Vaseline and put that on the area a couple of times a day.

Now we repeat this procedure usually two to three times a week, for usually four to six weeks. And then you’re done. Now as you’ll see from these pictures, you will see us gradually go from not seeing any reaction on the skin from the radiation, through the treatment, to the end of the treatment, where you will see a nice red area that looks very irritated. After the treatment is done, that irritation tends to increase for about the next two weeks and then slowly subside. The scar that’s left from superficial radiation often is just tissue texture changes, so the texture of the skin doesn’t quite look like normal texture. Sometimes there’s some coloration issues. So sometimes it can be a little lighter than the surrounding skin or even a little darker. And sometimes there’s some increased blood vessel formation in the area that was treated.

Now there are other complications that can happen from superficial radiation. If we’re doing a spot on the lip and you happen to get cold sores, you might get a cold sore outbreak. If you have a history of cold sores and we’re treating a localized area on the lip, please let your dermatologist know so that we can give you medication to prevent that. There are other complications that can happen from superficial radiation, and you can see those here in this list.

Now no treatment modality is a hundred percent. So no matter what you’re treating your non-melanoma skin cancer with, you do need to look at the area once a month in the mirror for the rest of your life, to make sure that you don’t see any signs or symptoms, of it coming back, like a bump or tenderness or any of these sorts of things. And it does mean that once you’ve had one non-melanoma skin cancer, you are prone to having more. So please look yourself over every month in the mirror to notice anything on your body that is new, changing, growing, or simply not healing.

Now what’s important for you to do is to have a conversation with your local dermatologist because Superficial Radiation Therapy is not the gold standard for treating non-melanoma skin cancers. It is a wonderful option for people who can’t take more surgeries, people who can’t handle the after surgical care of a surgery, people who are deathly afraid of needles, people who have a cancer on an area like the nose, the lips, or the ears, that’s hard to reconstruct cosmetically. And all of these are good reasons for not doing the standard of care of an excisional technique for the non-melanoma skin cancer. It’s a wonderful treatment modality when used appropriately.

So please if you have any of these conditions that are listed, and you’re concerned about having a surgical approach for your non-melanoma skin cancer, please ask your local dermatologist if superficial radiation might be appropriate for you.

About the author

Dr. Anderson with Doctors Quarterly Magazine - Cropped
Dr. Reagan Anderson

Dr. Anderson is a Board Certified Dermatologist and Mohs Micrographic Surgeon. He serves as a Clinical Professor of Dermatology and is actively involved in patient and healthcare provider education on dermatology conditions and treatment.

Colorado Dermatology Institute
8580 Scarborough Drive / 1220 Lake Plaza Drive
Colorado Springs, Colorado