Superficial Radiation Therapy: A Viable Nonsurgical Option for Treating Basal and Squamous Cell Carcinoma of the Lower Extremities

February 2019 | Volume 18 | Issue 2 | Original Article | 130 | Copyright © February 2019

William I. Roth MD, Michael Shelling MD, Keren Fishman

Dermatology and Dermatological Surgery, Boynton Beach, FL

Abstract
Background: Superficial radiation therapy (SRT) is a nonsurgical method of treating basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) lesions on the lower extremities of older individuals that might otherwise suffer complications or prolonged healing following surgical intervention. Objective: The goal of this study was to evaluate the effectiveness of SRT for treating BCC and SCC lesions on the lower extremities of elderly patients in an outpatient clinic setting. Methods and Materials: A retrospective review was performed using data from consecutive patients with BCC and SCC on their lower extremities and were treated with SRT. Results: The review included patients with biopsy-proven BCC (n=38, 25%) and SCC (n=113, 75%). The mean patient age was 82.5 years and the follow-up period was ≥4 years (32%), 3 years (30%), 2 years (20%), and ≤2 years (17%). The overall success rate was over 97%. Four lesions (one BCC and three SCCs) recurred equally between genders (2 males and 2 females) with lesions >1.0 cm and all lesions were eventually cleared with other modalities. Conclusions: Superficial radiation therapy is an effective option for eliminating BCC and SCC on lower extremities of patients who opt for nonsurgical treatment. Using SRT for BCC and SCC in elderly patients resulted in a 97.4% cure rate. J Drugs Dermatol. 2019;18(2):130-134.

INTRODUCTION

Nonmelanoma skin cancer (NMSC), consisting primarily of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), represents the most commonly encountered type of cancer. As advanced age is a significant risk factor for developing NMSC, it is an increasing health concern among the growing population of older adults.1,2 Currently, more than 50% of all skin cancer are diagnosed in patients 65 years and older and this proportion is expected to increase to as many as 70% by 2030.3The high prevalence of NMSC in this patient population is the result of a lifetime of cumulative exposure to carcinogens, primarily ultraviolet radiation. Consequently, most NMSC occurs on sun-exposed areas, such as the face.4,5 Although mortality rates from BCC and SCC are relatively low, it is possible for lesions to become disfiguring or metastatic if left untreated.6-10 Unfortunately, as the incidence of NMSC increases with advancing age, wound healing decreases. This is due to normal intrinsic age-related changes in the structure and function of the skin which affect the healing process11,12 and also extrinsic factors such as photodamage.13Superficial radiation therapy (SRT) has re-emerged as an effective and noninvasive means for treating NMSC.14 SRT can achieve good disease control and high curerates, with good cosmetic results and acceptable recurrence rates. SRT reprerepresents a useful treatment option in frail, elderly patients15 and may be preferable to surgery in older patients with limited life expectancy.16,17 This patient population often presents with numerous co-morbidities such as diabetes, stasis dermatitis, chronic edema, and various cardiovascular diseases,18,19 making them poor surgical candidates. This is especially true for NMSC lesions on the lower limbs.The objective of the following study was to further demonstrate the effectiveness of SRT for the treating BCC and SCC on the lower extremities of elderly patients in an outpatient clinic.

METHODS

This retrospective study reviewed medical records from a private dermatology practice. All patients with biopsy-proven, primary cutaneous BCC and SCC lesions on the lower extremities and treated with SRT between 2011 and 2014 were identified. Patients who would not have been treated with SRT, including patients with very large tumors, histologically aggressive tumors, such as poorly defined SCCs, sclerosing or morpheaform tumors, perineural involvement, metatypical tumors, and patients who were under 65 years of age were excluded from the study.Privacy of subjects and confidentiality of the collected data elements was secured through use of a de-identified coding