Nonmelanoma skin cancer (NMSC) remains a significant health concern globally, with various treatment modalities available to address its diverse presentations. In this quick-hitting installment of Topical Conversations, Aaron Farberg, MD, discusses the role of superficial radiation therapy (SRT) for the treatment of NMSC. 

The NMSC treatment landscape 

The treatment landscape for NMSC encompasses an array of options, including surgery, cryotherapy, curettage and electrodessication, and radiation therapy (RT). RT includes several techniques such as SRT, photodynamic therapy, brachytherapy, and chemotherapeutic agents. Treatment decisions hinge on several factors, including tumor type, anatomical location, patient characteristics, and physician preference.¹ 

Historical context and resurgence of SRT 

SRT, one of the oldest modalities for NMSC, witnessed widespread use in dermatology practice until the mid-20th century. However, its utilization dwindled with the emergence of surgical techniques and the unavailability of replacement SRT devices. Moreover, the lack of training opportunities in dermatology residency programs further contributed to its decline.¹ 

However, SRT has begun to experience a renaissance as advocates strive to fill knowledge gaps regarding its use and demonstrate its efficacy with large studies. One study found that using SRT for basal cell carcinoma and squamous cell carcinoma in elderly patients resulted in a 97.4% cure rate.² Another estimated that 98.8% of NMSCs will not recur after 85 months following SRT.³ 

Alternative to surgical modalities 

In instances where tissue-sparing must be considered, SRT may be a favorable alternative to surgery, mitigating undesirable cosmetic and functional consequences. Moreover, certain patient cohorts, particularly those unsuitable for surgery due to advanced age or medical comorbidities, may benefit from SRT's noninvasive approach.¹ 

In conclusion, SRT has reemerged as a viable treatment modality for NMSC, offering comparable efficacy to surgical options with superior cosmesis in select cases. Its historical significance, coupled with recent advancements and favorable outcomes, underscores the need for dermatologists to reevaluate its role in contemporary practice. By leveraging SRT's benefits and tailoring treatment approaches to individual patient needs, dermatologists can optimize outcomes and enhance the quality of care for NMSC patients. 

References 

1. Nestor MS, Berman B, Goldberg D, et al. Consensus guidelines on the use of superficial radiation therapy for treating nonmelanoma skin cancers and keloids. J Clin Aesthet Dermatol. 2019;12(2):12-18. 
2. Roth WI, Shelling M, Fishman K. Superficial radiation therapy: a viable nonsurgical option for treating basal and squamous cell carcinoma of the lower extremities.. J Drugs Dermatol. 2019;18(2):130-134. 
3. Roth W, Beer RE, Iyengar V, Bender T, Raymond I. Long-term efficacy and safety of superficial radiation therapy in subjects with nonmelanoma skin cancer: a retrospective registry study. J Drugs Dermatol. 2020;19(2):163-168. doi:10.36849/JDD.2020.4647