January 24, 2012

Could radiation therapy be making its way back to the dermatologists' toolbox for treating skin cancer? Maybe, said Dr. James M. Spencer.

The once gigantic machines used for radiation are being replaced by smaller ones, and treatment methods and calculations are getting simpler, said Dr. Spencer, at the Orlando Dermatology Aesthetic and Clinical Conference.

However, radiation therapy for skin cancer is somewhat of a paradox. It's cumbersome, expensive (J. Am. Acad. Dermatol. 2009:96-103), and has a rigorous treatment regimen.

On the other hand, it has an excellent 5-year cure rate for basal cell carcinoma (J. Dermatol. Surg. Oncol. 1989;15:315-28), said Dr. Spencer, conference chair, and professor of clinical dermatology at Mount Sinai School of Medicine, New York.

But the long-term consequences of radiation therapy can't be ignored. The cosmetic outcome for radiation therapy sites gets worse as each year passes, while surgery "scars get better every day of your life," said Dr. Spencer.

There is also an increased risk for BCC in patients who have had radiation therapy, especially during childhood. So, while it's an effective treatment method for nonmelanoma skin cancers, it’s not an appropriate treatment for younger patients.

It may, however, be a good option for older patients who are less concerned with cosmetic outcomes in the long run. In fact, radiation therapy yields great cosmetic outcomes in the first 3 to 4 years.

Radiation therapy can also be used as combination treatment for cancers such as Merkel cell carcinoma.

Today, radiation therapy is mainly the domain of radiation oncologists, said Dr. Spencer. For skin cancer therapy, the field of dermatology has turned its attention to surgery, and medical therapies such as topical imiquimod, while radiation is rarely used.

Dr. Spencer reported having no relevant financial conflicts.

-Naseem Miller (on Twitter @NaseemSMiller)

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