Skin cancer video


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Skin cancer video

  1. 1. Radiation Treatment of Skin Cancer (basal or squamous) Robert Miller MD Does it work? What are the results? What are the side effects?
  2. 2. Basal Cell CarcinomaBasal cell carcinoma (BCC): About 80% of all skin cancersare BCC, a cancer that develops in the basal cells - skin cellslocated 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 tendto grow slowly and can take years to reach ½ inch in size. Whilethese tumors very rarely metastasize
  3. 3. Squamous Cell CarcinomaSquamous cell carcinoma (SCC): About 16% of diagnosed skincancers are SCC. This cancer begins in the squamous cells, whichare found in the upper layer of the epidermis. SCC tends to developin fair-skinned middle-aged and elderly people who have had long-term sun exposure
  4. 4. Literature Review (untreated basal cell) Number of Technique Local Control Casessurgical excision 2,606 90%radiation therapy 4,695 91% curettage and 3,573 92% electr. cryotherapy 269 93% Mohs 7,670 99% microsurgery
  5. 5. Literature Review (recurrent basal cell) Number of Technique Local Control Casessurgical excision 522 83%radiation therapy 234 87% curettage and 115 60% electr. Mohs 3,009 94% microsurgery
  6. 6. 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
  7. 7. 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%
  8. 8. Mohs Surgery for High Risk Squamous /Cure Rates Comparing Mohs and other RxFeatures Mohs Other2cm or larger 75% 58%Recurrent 90% 77%Poorly Diff. 67% 46%Perineural 92% 53%
  9. 9. Cosmetic Results and Comparisons Surgery
  10. 10. SurgeryMohssurgerythenflap
  11. 11. Patient treated with Surgery. Generally the cosmetic results ofradiation are better than surgery if a skin graft is required Site of skin graft
  12. 12. Often the long term cosmetic results withradiation will be superior to surgery on the nose
  13. 13. Radiation may get better cosmetic resultsthan with surgery
  14. 14. Radiation for Skin CancerElectron beam for largeareas. Daily (Mon-Fri) for 3– 6 weeks
  15. 15. A block or shield is made to expose theskin that needs to be treated with electrons
  16. 16. A Shield is Designed to Block the Radiation fromhitting the normal skin and just the target area
  17. 17. How many treatments?
  18. 18. Basal Cell And Radiation
  19. 19. Generally small cancers heal quickly
  20. 20. Squamouscancer onthe leg ,healingmay beslower onthe legs
  21. 21. Cosmetic Results. In most patients there isno visible sign of treatment after radiation
  22. 22. Radiation for squamous cancer of the ear
  23. 23. Radiation for basal cell cancer of theforehead Before radiation 1 month after radiation Sometimes the treated area looks more pale than the rest of the skin
  24. 24. Radiation is good for large areas on the scalpthat would have required a skin graft
  25. 25. Years after radiationthe skin may look morepale93 yo woman this areawas treated withradiation 9 years before
  26. 26. HDR = high dose rate machine that canrun radiation through a tube that reachesthe patient through skin applicators
  27. 27. Radiation for Skin CancerHDR skin applicators – three times a weekfor 6 treatments over a two week period
  28. 28. The HDR Skin applicator is taped inplace over the cancer
  29. 29. The applicator is attached by cable to the machine thatmakes it radioactive for a few minutes
  30. 30. HDR for SkinCancer on theShin
  31. 31. HDR for Skin Cancer on the Foot
  32. 32. HDR for Skin Cancer on the Foot78 yo woman with squamous cancer
  33. 33. Results with HDR Skin applicator for small basal cell cancers on the face
  34. 34. HDR for Basal Cell on the Nose, appearance ofthe skin 10 months after radiation
  35. 35. Small squamouscancer of the chin,appearance 3.5weeks afterradiation (HDR)
  36. 36. Skin 12 months afterradiation
  37. 37. Results with HDR for skin on shin
  38. 38. 86 yo woman with small basal cell on hershin, 5 months after HDR
  39. 39. 86 yowoman
  40. 40. Radiation forareas difficult tooperate,squamous cancerof the fingerbefore and 19days afterelectron beam
  41. 41. Even large or neglected skin cancers usually heal well with radiation
  42. 42. Appearanceat 2 months
  43. 43. Appearance at3 months
  44. 44. Appearance at 5 months
  45. 45. A large ,neglectedbasal cellcancer on theleft side of thenose, healedcompletelywith radiation,avoiding majorsurgery
  46. 46. Side Effects of Skin RadiationThe treated skin will get red, itchy and sunburned. Thereare a number of good creams than can be used includingAloe, Aquaphor, Sween, Biafine, or SilvadeneThe skin reaction may show up in a delayed manner(worse at 1-2 weeks) and may develop slight, superficialulceration or crusting, but heals quickly (1-2 weeks)except the shin which heals more slowly
  47. 47. Side Effects of Skin Radiation
  48. 48. Side Effects ofSkin RadiationLast day oftreatment (largeelectron beamfields for basalcell…55Gy
  49. 49. With electronbeam theskin will getmoderatelysun-burnedby the lastday, butusually healsup in 2 to 3weeks
  50. 50. Side Effects of Skin RadiationBY the last day the skin may be sunburned and slightlyblistered with some drainage… about a week after stoppingradiation it starts to heal quickly and usually by 3 weeks thereis just some dry crusting or scabbing remaining
  51. 51. The radiated skin will get sunburnedRadiation target Last day of treatment
  52. 52. First day Last dayTwo weeks Two Years
  53. 53. Side Effects of Skin Radiation
  54. 54. The radiated skin will get sunburned Before Radiation Last Day
  55. 55. Along with skin redness, there may be somecrusting and peeling of the skin Obvious cancerLarge area of recurrent basal cell , before and on the last day ofelectron beam radiation , this usually heals up by 2 to 3 weeks
  56. 56. Same patientthree weekslater
  57. 57. Radiation Side Effects from HDR on theForehead1st day 1 week after 3 weeks
  58. 58. Time to healing after high doseSquamous cancer last day of radiation electron beam radiation 1 month later 7 months later
  59. 59. RecurrentBasal cellcancer on theleft foreheadof an elderlywoman
  60. 60. Time to skin healing
  61. 61. Often the peak skin reaction shows up abouttwo weeks after completing the radiation (espwith HDR)
  62. 62. Delayed Skin Reaction with HDRcancer over the shin in elderly patients maytake weeks to months to heal up completely
  63. 63. The scab may take a few weeks to fall off
  64. 64. Typical time period 82 yo woman with squamouscancer on the shin treated with electron beam radiation
  65. 65. Cancers on the shin in elderly patients can be slow to heal
  66. 66. Sometimes the skin superficially ulcerates, 76 yo man with recurrent basal cell templeFirst day Last Day Radiation 3 weeks later
  67. 67. Radiation will result in hair loss over thescalp, it does not always grow back Before radiation 3 weeks after completion
  68. 68. Radiation Treatment of SkinCancer (basal or squamous) Robert Miller MD