These are the slides that accompany the video found on www.aboutcancer.com

1. Radiation Treatment of Skin
Cancer (basal or squamous)
Robert Miller MD
www.aboutcancer.com
 Does it work?
 What are the results?
 What are the side effects?

2. 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.
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

3. 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

7. Literature Review (untreated basal cell)
Number of
Technique Local Control
Cases
surgical excision 2,606 90%
radiation therapy 4,695 91%
curettage and
3,573 92%
electr.
cryotherapy 269 93%
Mohs'
7,670 99%
microsurgery

8. Literature Review (recurrent basal cell)
Number of
Technique Local Control
Cases
surgical excision 522 83%
radiation therapy 234 87%
curettage and
115 60%
electr.
Mohs'
3,009 94%
microsurgery

9. Control Rate with Radiation, 3 Large Series
Basal Cell 98% 95% 96%
Squamous Cell 92% 87% 88%
Control Rates with Radiation
Type Untreated Relapsed
Basal Cell 95% 82%
Squamous
87% 65%
Cell

10. Control by Tumor Size with Radiation
Size Control Rate
< 2 cm 99%
2 - 5 cm 92%
> 5 cm 60%
Skin Damage with Radiation
Size Skin Damage
< 1cm 0.9%
1 - 5 cm 6.5%

11. Mohs Surgery for High Risk Squamous /
Cure Rates Comparing Mohs and other Rx
Features Mohs Other
2cm or larger 75% 58%
Recurrent 90% 77%
Poorly Diff. 67% 46%
Perineural 92% 53%

12. Cosmetic Results and Comparisons
Surgery

13. Surgery
Mohs
surgery
then
flap

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

15. Often the long term cosmetic results with
radiation will be superior to surgery on the nose

16. Radiation may get better cosmetic results
than with surgery

17. Radiation for Skin Cancer
Electron beam for large
areas. Daily (Mon-Fri) for 3
– 6 weeks

18. A block or shield is made to expose the
skin that needs to be treated with electrons

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

20. How many treatments?

21. Basal Cell And Radiation

22. Generally small cancers heal quickly

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

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

26. Radiation for squamous cancer of the ear

27. Radiation for basal cell cancer of the
forehead
Before radiation 1 month after radiation
Sometimes the treated area looks more pale
than the rest of the skin

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

29. Years after radiation
the skin may look more
pale
93 yo woman this area
was treated with
radiation 9 years before

30. HDR = high dose rate machine that can
run radiation through a tube that reaches
the patient through skin applicators

31. Radiation for Skin Cancer
HDR skin applicators – three times a week
for 6 treatments over a two week period

32. The HDR Skin applicator is taped in
place over the cancer

33. The applicator is attached by cable to the machine that
makes it radioactive for a few minutes

34. HDR for Skin
Cancer on the
Shin

35. HDR for Skin Cancer on the Foot

36. HDR for Skin Cancer on the Foot
78 yo woman with squamous cancer

37. Results with HDR Skin applicator for
small basal cell cancers on the face

38. HDR for Basal Cell on the Nose, appearance of
the skin 10 months after radiation

39. Small squamous
cancer of the chin,
appearance 3.5
weeks after
radiation (HDR)

40. Skin 12 months after
radiation

41. Results with HDR for skin on shin

42. 86 yo woman with small basal cell on her
shin, 5 months after HDR

43. 86 yo
woman

45. Radiation for
areas difficult to
operate,
squamous cancer
of the finger
before and 19
days after
electron beam

46. Even large or neglected skin cancers
usually heal well with radiation

47. Appearance
at 2 months

48. Appearance at
3 months

49. Appearance at 5 months

50. A large ,
neglected
basal cell
cancer on the
left side of the
nose, healed
completely
with radiation,
avoiding major
surgery

52. 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

53. Side Effects of Skin Radiation

54. Side Effects of
Skin Radiation
Last day of
treatment (large
electron beam
fields for basal
cell…55Gy

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

56. Side Effects of Skin Radiation
BY the last day the skin may be sunburned and slightly
blistered with some drainage… about a week after stopping
radiation it starts to heal quickly and usually by 3 weeks there
is just some dry crusting or scabbing remaining

57. The radiated skin will get sunburned
Radiation target Last day of treatment

58. First day Last day
Two weeks Two Years

59. Side Effects of Skin Radiation

61. The radiated skin will get sunburned
Before Radiation Last Day

62. Along with skin redness, there may be some
crusting and peeling of the skin
Obvious cancer
Large area of recurrent basal cell , before and on the last day of
electron beam radiation , this usually heals up by 2 to 3 weeks

63. Same patient
three weeks
later

64. Radiation Side Effects from HDR on the
Forehead
1st day 1 week after 3 weeks

65. Time to
healing after
high dose
Squamous cancer last day of radiation electron beam
radiation
1 month later 7 months later

67. Recurrent
Basal cell
cancer on the
left forehead
of an elderly
woman

68. Time to skin healing

70. Often the peak skin reaction shows up about
two weeks after completing the radiation (esp
with HDR)

71. Delayed Skin Reaction with HDR
cancer over the shin in elderly patients may
take weeks to months to heal up completely

72. The scab may take a few weeks to fall off

73. Typical time
period
82 yo woman
with squamous
cancer on the shin
treated with
electron beam
radiation

74. Cancers on the shin in elderly patients can be
slow to heal

75. Sometimes the skin superficially ulcerates, 76 yo
man with recurrent basal cell temple
First day Last Day Radiation 3 weeks later

76. Radiation will result in hair loss over the
scalp, it does not always grow back
Before radiation 3 weeks after completion

77. Radiation Treatment of Skin
Cancer (basal or squamous)
Robert Miller MD
www.aboutcancer.com