September 06, 2010
Dermatology Associates is a seven-person dermatology group with two Mohs surgeons, a fellow, an in-house plastic surgeon, and a dermatopathologist. We care for patients referred to us from about a 100-mile radius by dermatologists in lower Alabama, South Georgia, and the Panhandle, as well as our own general dermatologists and local and regional physicians.
Many of our patients have multiple cancers at the time of referral. Depending on the location, size, depth, and aggressiveness of the individual tumor, juxtaposed to the patient’s age and health status we discuss Mohs vs SRT as part of informed consent. We discuss radiation with all patients over 65 with the option of treatment either here in the office or by radiation oncology. We end up using it in about 10% of these patients over 65 who are referred for Mohs surgery. We have been doing this successfully for 25+ years and recently calculated our 10- year cure rates, which compare very favorably to Mohs surgery.
The patient is a 103-year-old white female who lived independently and drove until two years ago. She still is quite independent and lives in an assisted living home. She has had a history of multiple skin cancers over the last 25 years, including some difficult and aggressive squamous cells on her face.
The patient presented with a pink crusted papule on her nasal tip, which would not heal. A biopsy showed this to be a superficial and nodular basal cell estimated depth less than 3 mm. She was given the option of observation or treatment and opted for treatment with superficial x-ray, which she had opted for in the past for other facial skin cancers with success.
The patient opted for superficial radiation treatment for this lesion. The lesion was circled and an appropriate shield size 1.6 cm was fashioned out of lead sheet 0.762 mm thick. Using the 3 cm cone, 5 fractions of 700 cGy were delivered at 60 kV, 10 ma with a D . of 9.6 mm. The patient received a total of 3,500 cGy to the area over a two week period.
The patient tolerated the treatment with no side effects. The patient returned two weeks post-op with a good erythematous reaction from the SRT treatment. This should give her a good chance of cure (see photos below).