Skin Cancer Radiotherapy

Radiotherapy is a very effective treatment for skin cancers such as basal cell carcinoma and squamous cell carcinomas. There are also other skin cancers that can be treated with radiotherapy and you can discuss your situation with a radiation oncologist.

A lifetime of sun exposure can predispose you to skin cancers. Have a skin cancer check. If your family physician shares your concerns, a biopsy will be required. If caught early, you may have a number of different treatment options that can be considered. Some of which, your own family physician can do for you. This could include freezing the skin cancer with liquid nitrogen, a minor operation, or the use of chemotherapy ointments as well.

If your skin cancer is more advanced or in a location that requires more care than that which can be delivered in your family physicians’ clinic, then you will need to see a specialist in skin cancer treatments. These specialists include surgeons, dermatologists or a radiation oncologist. There are pros and cons to different approaches to treatment of skin cancers and I would recommend you have a discussion with more than one specialist before you decide on your preferred treatment option or combination.

Some skin cancers are better suited to surgery as cutting it out will be a single process and the wound may be easily closed with simple sutures or the wound may require a relatively incomplex flap or graft. Skin cancers on areas where there is loose skin such as the arms and legs are much simpler to treat with a resection (a surgery to remove tissue). This is especially so if the skin cancer can be removed completely achieving negative margins (this means that there is no skin cancer left at the wound site).

Skin cancers that are very thick or which deeply invade the underlying tissues including bone or which are close to sensitive structures such as the eye, nose, lips or ears usually require discussion between specialists such as surgeons and radiation oncologists. Scans may also be required in some of these situations. These scans are used to assess how extensively the skin cancer has spread below the skin, if it’s travelled into nerves and if it has travelled or metastasized to the glands, which are called nodes. The scan may also pick up if the skin cancer has spread more extensively to other regions such as the lungs or bone amongst other regions. Unfortunately, skin cancers that have spread extensively are not curable. It is therefore important that skin cancers are treated sooner before they metastasize.

It is best medical practice that advanced skin cancers get reviewed from a group of different specialists that work together. Your surgeon or radiation oncologist may organize this if it’s required in your case. This group is referred to as a multidisciplinary meeting or tumour board. Members of these meetings can include general surgeons, head and neck surgeons, plastic surgeons, dermatologist, medical oncologist, radiologist, pathologist and nurses.

Skin cancers that have invaded deeply and are no longer able to be removed by a surgeon due to the risk it involves or will result in unacceptable cosmetic disfigurement, may be treated directly with radiotherapy. Skin cancers close to sensitive structures as the eyelids, corner of the eye, on the nose or close to the nose, skin around the lips or the lips themselves as well as the ears, are commonly treated by a number of means be it surgery or radiotherapy. Resection of these skin cancers sometimes require complex reconstructive work or may result in poor function of the surrounding facial features, which then may make it better suited for radiotherapy alone. Such assessments are best made by an experienced surgeon with expertise in reconstruction and discussion with a radiation oncologist.

A radiation oncologist will assess the features of the skin cancer and advise you of the likely radiotherapy technique and machine best suited for the treatment. It may require marking out the tumour and a margin around it with a felt marker, similar to the margin a surgeon may want to help cure you of the skin cancer. A bolus, which is a rubbery slab, is sometimes used as well for the treatment and is placed on the area your radiation oncologist wants to deliver a particular dose to. If the skin cancer is on the face or neck region, a mask over the head and neck region is also customized to fit you in a separate session. This ensures you maintain the same position and help with the precision of the treatment. Some radiotherapy techniques will also require you to undergo a CT simulation scan as part of the radiotherapy planning process. Depending on the extent of the skin cancer and treatment complexity, your treatment may require several sessions over a period of time. Some treatments only require a few days while others up to 6 weeks. All treatments are done as an out-patient.

The side effects from radiotherapy depend on a number of factors. These include the previous treatments you’ve had, the surrounding structures that are within the radiotherapy field, the dose, the techniques used and your underlying medical conditions as well. These side effects are best discussed with a radiation oncologist. Common side effects can however include, skin inflammation, itchiness, peeling of the skin, dryness, discomfort, long term skin changes such as color and texture as well as dryness as well as loss of hair in the irradiated region. Uncommon but severe side effects can include permanent injury to the flesh or bone and result in ulcer or bone/cartilage injury called osteo-radio necrosis.

By far, most radiotherapy treatments alone for skin cancers result in a high rate of cure and are noninvasive, without the need for complex reconstructive work with no scars being formed. Some situations do however need collaboration with both surgical removal of the tumour and post operative radiotherapy to achieve a better outcome. Having an in-depth discussion with a team that works together will help in a better treatment plan for you.

Further information about radiotherapy for skin cancers can be found on the EVIQ website.

© Ramesh Pandey March 2025